Price Transparency

OVERVIEW 

In compliance with the Centers for Medicare and Medicaid Services (CMS), Collingsworth General Hospital is making available to the public a copy of its standard charges known as a “Charge Master,” “Charge Description Master” or “CDM”.

Since payment rates for hospital care provided to insured patients are either negotiated with health plans, set by the federal government for Medicare, or set by state governments for Medicaid enrollees, the payments hospitals receive for patient care do not necessarily reflect the prices reflected in the Charge Master.  A patient’s responsibility may vary depending on the payment plans negotiated with insurance companies as well as the patient’s individual and/or family deductibles and co-payments with their insurance plan.  Additionally, uninsured patients are not generally expected to pay the hospital’s standard charges as reflected in the CDM and may be eligible for financial assistance.

The information provided is based on information we have gathered from contracts with managed care commercial insurance plans.  This is not a guarantee of what you will be charged. Your actual charges may differ from the estimated charges for many reasons, including the seriousness of your medical condition, actual time the procedure takes and the services and supplies that you receive.

The charges listed here are for services from the Hospital.  They do not reflect the charges for physicians (such as surgeon, anesthesiologist, radiologist, pathologist, etc.) who may be involved in providing particular services to a patient. These charges are billed separately from the individual physician/physicians group.

Collingsworth General Hospital shall not be liable for any difference between charges listed in the price lists and the final bill for services.

AVAILABLE FILES 
There are two files regarding the hospital’s CDM for price transparency. 

The CSV file is a comprehensive, machine-readable file that makes public all standard charge information for all hospital items and services.  This can easily be imported into Microsoft Excel or similar software. This file contains the following information: 

  • Charge Code – specific charge code for each item or service
  • Description – description of each item or service
  • Department – department where item or service performed
  • Rev Code – corresponding department’s revenue code for item or service
  • CPT Code – corresponding CPT billing code for item or service (if applicable)
  • Gross Charge – corresponding gross charge for each individual item or service
  • Cash Price – corresponding discounted cash price that applies to each item or service
  • Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header
  • De-identified minimum negotiated charge that applies to each item or service
  • De-identified maximum negotiated charge that applies to each item or service

The PDF file is a searchable consumer-friendly format of payer-specific negotiated charge information of 300 “shoppable outpatient services” at the hospital.  The file contains the following information: 

  • Charge Code – specific charge code for each item or service
  • Description – description of each item or service
  • Department – department where item or service performed
  • Rev Code – corresponding department’s revenue code for item or service
  • CPT Code – corresponding CPT billing code for item or service (if applicable)
  • Gross Charge – corresponding gross charge for each individual item or service
  • Cash Price – corresponding discounted cash price that applies to each item or service
  • Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header
  • De-identified minimum negotiated charge that applies to each item or service
  • De-identified maximum negotiated charge that applies to each item or service

QUESTIONS?

If you have further questions about the Collingsworth General Hospital CDM, please contact our hospital business office at (806) 447-2521 or come by and speak to one of our business office representatives.  Thank you for choosing Collingsworth General Hospital for your health care needs! 

Downloadable CDM and Shoppable Services

Charge Description Master

Shoppable Services

Searchable Shoppable Services

Collingsworth General Hospital Shoppable Services as of 7/01/2024

descriptioncode|1code|1|typecode|2code|2|typecode|3code|3|typemodifierssettingdrug_unit_of_measurementdrug_type_of_measurementstandard_charge|grossstandard_charge|discounted_cashstandard_charge|Aetna Commercial|negotiated_dollarstandard_charge|Aetna Commercial|negotiated_percentagestandard_charge|Aetna Commercial|negotiated_algorithmestimated_amount|Aetna Commercialstandard_charge|Aetna Commercial|methodologyadditional_payer_notes|Aetna Commercialstandard_charge|Aetna Medicare Advantage|negotiated_dollarstandard_charge|Aetna Medicare Advantage|negotiated_percentagestandard_charge|Aetna Medicare Advantage|negotiated_algorithmestimated_amount|Aetna Medicare Advantagestandard_charge|Aetna Medicare Advantage|methodologyadditional_payer_notes|Aetna Medicare Advantagestandard_charge|BCBS|Blue Advantage|negotiated_dollarstandard_charge|BCBS|Blue Advantage|negotiated_percentagestandard_charge|BCBS|Blue Advantage|negotiated_algorithmestimated_amount|BCBS|Blue Advantagestandard_charge|BCBS|Blue Advantage|methodologyadditional_payer_notes|BCBS|Blue Advantagestandard_charge|BCBS|HMO|negotiated_dollarstandard_charge|BCBS|HMO|negotiated_percentagestandard_charge|BCBS|HMO|negotiated_algorithmestimated_amount|BCBS|HMOstandard_charge|BCBS|HMO|methodologyadditional_payer_notes|BCBS|HMOstandard_charge|BCBS|PPO|negotiated_dollarstandard_charge|BCBS|PPO|negotiated_percentagestandard_charge|BCBS|PPO|negotiated_algorithmestimated_amount|BCBS|PPOstandard_charge|BCBS|PPO|methodologyadditional_payer_notes|BCBS|PPOstandard_charge|BCBS|Traditional|negotiated_dollarstandard_charge|BCBS|Traditional|negotiated_percentagestandard_charge|BCBS|Traditional|negotiated_algorithmestimated_amount|BCBS|Traditionalstandard_charge|BCBS|Traditional|methodologyadditional_payer_notes|BCBS|Traditionalstandard_charge|CIGNA Commercial|negotiated_dollarstandard_charge|CIGNA Commercial|negotiated_percentagestandard_charge|CIGNA Commercial|negotiated_algorithmestimated_amount|CIGNA Commercialstandard_charge|CIGNA Commercial|methodologyadditional_payer_notes|CIGNA Commercialstandard_charge|FirstCare|HMO|negotiated_dollarstandard_charge|FirstCare|HMO|negotiated_percentagestandard_charge|FirstCare|HMO|negotiated_algorithmestimated_amount|FirstCare|HMOstandard_charge|FirstCare|HMO|methodologyadditional_payer_notes|FirstCare|HMOstandard_charge|FirstCare|PPO|negotiated_dollarstandard_charge|FirstCare|PPO|negotiated_percentagestandard_charge|FirstCare|PPO|negotiated_algorithmestimated_amount|FirstCare|PPOstandard_charge|FirstCare|PPO|methodologyadditional_payer_notes|FirstCare|PPOstandard_charge|HealthSource Commercial|negotiated_dollarstandard_charge|HealthSource Commercial|negotiated_percentagestandard_charge|HealthSource Commercial|negotiated_algorithmestimated_amount|HealthSource Commercialstandard_charge|Healthsource Commercial|methodologyadditional_payer_notes|HealthSource Commercialstandard_charge|Humana Commercial|negotiated_dollarstandard_charge|Humana Commercial|negotiated_percentagestandard_charge|Humana Commercial|negotiated_algorithmestimated_amount|Humana Commercialstandard_charge|Humana Commercial|methodologyadditional_payer_notes|Humana Commercialstandard_charge|United Commercial|negotiated_dollarstandard_charge|United Commercial|negotiated_percentagestandard_charge|United Commercial|negotiated_algorithmestimated_amount|United Commercialstandard_charge|United Commercial|methodologyadditional_payer_notes|United Commercialstandard_charge|minstandard_charge|maxadditional_generic_notes
SWINGBED ROOM1018CDM110RCinpatient5503853647999999999 Per diem36473647
PRIVATE ROOM1001CDM110RCinpatient6004201298999999999 Per diem3837999999999 Per diem2860999999999Per diem2990999999999Per diem3250999999999Per diem3250999999999Per diem1000999999999Per diem850999999999Per diem850999999999Per diem3900.65999999999Percent of total billed charges1000999999999Per diem1200999999999Per diem3903837
ACCUCHECK (BLOOD SUGAR)120922CDM250RC82948CPTboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges29.74999999999Fee schedule31.05999999999Fee schedule33.77999999999Fee schedule33.77999999999Fee schedule1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.4433.77
COVID Vaccine Admin2500001ACDM250RC90480CPTboth0.01
Prevnar 202500585CDM250RC90677CPTboth6004205100.85999999999 Percent of total billed charges5460.91999999999 Percent of total billed charges4680.78999999999Percent of total billed charges4500.75999999999Percent of total billed charges5220.87999999999Percent of total billed charges432.60.721999999999Percent of total billed charges432.6546
COVID Vaccine25091300CDM250RC91301CPTboth0.01
COVID-19 Vaccine J&J25091303CDM250RC91303CPTboth0.01
COVID admin Pfizer 3rd dose2500003ACDM250RC0003ACPTboth0.01
COVID admin Moderna Booster2500013ACDM250RC0013ACPTboth0.01
COVID-19 Vaccine J&J Administration2500031ACDM250RC0031ACPTboth0.01
Gammagard 20gm/200ml2500588CDM250RCJ1569CPTboth5280369644880.85999999999 Percent of total billed charges4804.80.91999999999 Percent of total billed charges4118.40.78999999999Percent of total billed charges39600.75999999999Percent of total billed charges4593.60.87999999999Percent of total billed charges3806.880.721999999999Percent of total billed charges3806.884804.8
Lovenox 10 MG121982CDM250RCJ1650CPTboth96.37.650.85999999999 Percent of total billed charges8.190.91999999999 Percent of total billed charges7.020.78999999999Percent of total billed charges8.95999999999Fee schedule6.750.75999999999Percent of total billed charges7.830.87999999999Percent of total billed charges6.490.721999999999Percent of total billed charges6.498.95
Ketorolac 15mg INJ.121984CDM250RCJ1885CPTboth32.12.550.85999999999 Percent of total billed charges2.730.91999999999 Percent of total billed charges2.340.78999999999Percent of total billed charges1.75999999999Fee schedule2.250.75999999999Percent of total billed charges2.610.87999999999Percent of total billed charges2.160.721999999999Percent of total billed charges1.752.73
Ketorolac 15mg/ml122015CDM250RCJ1885CPTboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges1.75999999999Fee schedule3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges1.754.55
Levofloxacin premix bag 250MG122009CDM250RCJ1956CPTboth6.924.845.880.85999999999 Percent of total billed charges6.30.91999999999 Percent of total billed charges5.40.78999999999Percent of total billed charges6.92999999999Fee schedule5.190.75999999999Percent of total billed charges6.020.87999999999Percent of total billed charges4.990.721999999999Percent of total billed charges4.996.92
Levaquin D5W 250MG IVPB121994CDM250RCJ1956CPTboth2114.717.850.85999999999 Percent of total billed charges19.110.91999999999 Percent of total billed charges16.380.78999999999Percent of total billed charges20.2999999999Fee schedule15.750.75999999999Percent of total billed charges18.270.87999999999Percent of total billed charges15.140.721999999999Percent of total billed charges15.1420.2
Fentanyl Citrate 100mcg121986CDM250RCJ3010CPTboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges0.21999999999Fee schedule30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges0.213.64
CLEOCIN 150MG120168CDM250RCJ3490CPTboth3625.230.60.85999999999 Percent of total billed charges32.760.91999999999 Percent of total billed charges28.080.78999999999Percent of total billed charges270.75999999999Percent of total billed charges31.320.87999999999Percent of total billed charges25.960.721999999999Percent of total billed charges25.9632.76
NITRO DRIP 5mg121161CDM250RCJ3490CPTboth9767.982.450.85999999999 Percent of total billed charges88.270.91999999999 Percent of total billed charges75.660.78999999999Percent of total billed charges72.750.75999999999Percent of total billed charges84.390.87999999999Percent of total billed charges69.940.721999999999Percent of total billed charges69.9488.27
ALBUTEROL INHAL.1MG120627CDM250RCJ7613CPTboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges0.49999999999Fee schedule4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges0.495.46
FAMOTIDINE 20MG INJ120577CDM250RCS0028CPTboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges1.13999999999Fee schedule8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges1.1310.01
PROTONIX 40MG IV121472CDM250RCS0164CPTboth7854.666.30.85999999999 Percent of total billed charges70.980.91999999999 Percent of total billed charges60.840.78999999999Percent of total billed charges58.50.75999999999Percent of total billed charges67.860.87999999999Percent of total billed charges56.240.721999999999Percent of total billed charges56.2470.98
MEGESTROL 400MG/10ML121132CDM250RCS0179CPTboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges0.66999999999Fee schedule30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges0.663.64
Prevnar 13 Vaccine 1 each122010CDM250RCS0195CPTboth370.25259.18314.710.85999999999 Percent of total billed charges336.930.91999999999 Percent of total billed charges288.80.78999999999Percent of total billed charges104.66999999999Fee schedule277.690.75999999999Percent of total billed charges322.120.87999999999Percent of total billed charges266.950.721999999999Percent of total billed charges104.66336.93
LIDOCAINE VISCOUS 2%120867CDM250RCboth0.01
LIDOCAINE/EPI 2% [20MG/ML-20 ML]2500274CDM250RCboth0.01
LIDOCAINE/EPI 1% INJ [10MG/ML]2500272CDM250RCboth0.01
BAMLANIVIMAB **IVPB**2500549CDM250RCboth0.01
CASIRIVIMAB/IMDEVIMAB** IVPB**2500565CDM250RCboth0.01
ETESEVIMAB INJ2500561CDM250RCboth0.01
1/2 NACL 0.9%/KCL 20 MEQ 1000 ML2500526CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ACETAMINOPHEN ES TAB 500 MG2500000CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ACETAMINOPHEN ORAL TABLET 325MG25000008CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ACETAMINOPHEN TAB 325 MG2500499CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ALBUTEROL 2.5 MG2500444CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ALBUTEROL 2.5MG/ 0.5 ML2500505CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ALENDRONATE TAB 70 MG250003CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ALLOPURINOL TAB 100MG2500004CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
AMITRIPTYLINE TAB [10 MG]2500372CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
AMOXICILLIN CAP [500 MG]2500160CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ASCORBIC ACID TAB [500 MG]2500151CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ASPIRIN CHEW TAB. 81 MG2500014CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
Aspirin Oral Tablet 325 MG2500015CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
BAM/ETES**IVPB**2500562CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
BIO GLO2500175CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
Bisacodyl Ec Tab 5 MG.2500019CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
BISACODYL SUPP [10 MG]2500206CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CALCIUM CHEW TAB [500 MG]2500148CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CALCIUM TAB [600 MG + D 400]2500147CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CHARCOAL SUSP [25 GM]2500568CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CIPROFLOXACIN TAB [500 MG]2500163CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CLONIDINE TAB [0.1 MG]2500028CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CROFAB 4GM**IVPB**/NS 250ML2500566CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CYCLOBENZAPRINE TAB [10 MG]2500030CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DELTASONE TAB [20 MG]2500115CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DELTASONE TAB [5 MG]2500114CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
Dexamethasone Oral Tablet 1 MG2500031CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DIAZEPAM TAB [2 MG]2500347CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DIAZEPAM TAB [5 MG]2500348CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DIGOXIN INJ [500 MCG/2 ML]25000246CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DILTIAZEM CD CAP [120 MG]2500038CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DILTIAZEM TAB [30 MG]2500463CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DIPHENHYDRAMINE CAP [25 MG]2500040CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DIPHENHYDRAMINE HCL SOLN 12.5MG/5ML2500564CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DOCUSATE CAP [100 MG]2500042CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ETHYL CHLORIDE/MEDIUM JET2500481CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FENTANYL TRANS PATCH [12 MCG]2500321CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FERROUS SULFATE TAB [325 MG]2500046CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FISH OIL CAP 1000 MG2500150CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FOLIC ACID TAB [1 MG]2500049CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FUL-GLO OPHT. STRIPS120362CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FUROSEMIDE INJ [40 MG/4 ML]2500254CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FUROSEMIDE TAB [20 MG]2500050CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FUROSEMIDE TAB [40 MG]2500051CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
GLIPIZIDE TAB [5 MG]2500057CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
GLIPIZIDE XL TAB [2.5 MG]2500056CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
GLYBURIDE TAB [5 MG]2500055CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
GLYCERIN SUPP ADULT 2 GM2500460CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
GNP All Day Allergy Oral Tablet 10 MG2500026CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
GUAIFENESIN-CODEINE SYRUP[100 MG/10 MG]2500550CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
HALOPERIDOL 1MG TABLETS2500541CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
HEMMORRHOIDAL SUPP2500540CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
HYDRALAZINE TAB [10 MG]2500058CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
HYDRALAZINE TAB [25 MG]2500059CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
HYDROCHLOROTHIAZIDE TAB [25 MG]2500060CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
HYDROCORTISONE TAB [5 MG]2500061CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
HYDROMORPHONE TAB [4 MG]2500336CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
IBUPROFEN TAB [200 MG]2500066CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
IBUPROFEN TAB [400 MG]2500067CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
IPRATROPIUM BROMIDE 0.02% NEB [0.5 MG/22500441CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
IVERMECTIN TAB 3 MG2500552CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
KCl in Dextrose-NaCl Intravenous Solutio2500528CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
KCL IVPB [10MEQ/100ML]2500567CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LACTULOSE [20GM/30ML]2500529CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LACTULOSE [20GM/30ML]2500530CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LANOLIN ANHYDROUS 30%2500482CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LIDOCAINE 4% SPRAY2500548CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LIDOCAINE VISCOUS 2% [15 ML]2500222CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LISINOPRIL TAB [10 MG]2500081CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LOPERAMIDE SOLN 1 MG7.5ML2500563CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LORAZEPAM TAB [0.5 MG]2500334CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LUBRICANT EYE DROPS2500477CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
MAALOX/GI COCKTAIL2500489CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
MAGNESIUM CITRATE2500532CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
MAG-OX TAB [400 MG]2500156CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
METOPROLOL TAR TAB [25 MG]2500093CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
NEOMYCIN/BACITRACIN/POLYMIXIN OINT2500203CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
NYSTATIN/TRIAMCINOLONE AC2500210CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
OCTREOTIDE DRIP2500559CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
OXYBUTYNIN TAB [5 MG]2500105CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
PANTOPRAZOLE TAB [40 MG]2500107CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SENNA TAB [8.6 MG]2500126CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SERTRALINE [25 MG]2500127CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SIMETHICONE 80MG TAB121488CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SIMETHICONE CHEW TAB [80 MG]2500129CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SODIUM CHLORIDE 0.9% NEB SOLUTION [3 ML]2500448CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SODIUM NITROPRUSSIDE 50 MG/2 mL2500573CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SOTROVIMAB/NS 50ML**IVPB**[500 mg/8 ml]2500569CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SPIRONOLACTONE TAB [25 MG]2500130CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SUCRALFATE TAB [1 GM]2500131CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
SULFAMETH/ TMP DS TAB [800-160 MG]2500381CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
TAB-A-VITE W/BETA CAROTEN2500154CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
TEMAZEPAM CAP [15 MG]2500349CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
TRAZODONE TAB [50 MG]2500138CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
TRIAMTER/ HCTZ CAP [37.5-25 MG]2500139CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
TRIPLE ANTIBIOTIC2500386CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
VENOFER 400 MG IVPB2500558CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
VITAMIN B-12 TAB [1000 MCG]2500152CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
VITAMIN D CAP [1000 UNIT]2500149CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
VITAMIN D3 CAP [5000 UNIT]2500143CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
XYLOCAINE 2% INJ [20 MG/ML]2500273CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ZINC SULFATE 220MG CAPS2500547CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ZOLPIDEM TAB [10 MG]2500352CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
LIDOCAINE INJ 1% [10 MG/ML]2500271CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CLINDAMYCIN/ 0.9% NS 600MG/50ML2500574CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
FLEET ENEMA 4.5oz2500575CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CALMOSEPTINE2500209CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
CALCIUM TAB [600 MG + D 400]2500520CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
MAG SULFATE **IVPB** 1GM/ NS 50ML2500577CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
DIGOXIN INJ [500 MCG/2 ML]2500246CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
NYSTATIN/TRIAMCINOLONE AC2500480CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
ACETAMINOPHEN/CODEINE LIQ2500333CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
Calcium Carbonate 500mg tab2500583CDM250RCboth10.70.850.85999999999 Percent of total billed charges0.910.91999999999 Percent of total billed charges0.780.78999999999Percent of total billed charges0.750.75999999999Percent of total billed charges0.870.87999999999Percent of total billed charges0.720.721999999999Percent of total billed charges0.720.91
METHOCARBAMOL TAB [500 MG]2500089CDM250RCboth1.020.710.870.85999999999 Percent of total billed charges0.930.91999999999 Percent of total billed charges0.80.78999999999Percent of total billed charges0.770.75999999999Percent of total billed charges0.890.87999999999Percent of total billed charges0.740.721999999999Percent of total billed charges0.740.93
PROPRANOLOL TAB [20 MG]2500118CDM250RCboth1.020.710.870.85999999999 Percent of total billed charges0.930.91999999999 Percent of total billed charges0.80.78999999999Percent of total billed charges0.770.75999999999Percent of total billed charges0.890.87999999999Percent of total billed charges0.740.721999999999Percent of total billed charges0.740.93
SERTRALINE [100 MG]2500128CDM250RCboth1.060.740.90.85999999999 Percent of total billed charges0.960.91999999999 Percent of total billed charges0.830.78999999999Percent of total billed charges0.80.75999999999Percent of total billed charges0.920.87999999999Percent of total billed charges0.760.721999999999Percent of total billed charges0.760.96
GUAIFENESIN LIQ [100 MG/5 ML]2500219CDM250RCboth1.080.760.920.85999999999 Percent of total billed charges0.980.91999999999 Percent of total billed charges0.840.78999999999Percent of total billed charges0.810.75999999999Percent of total billed charges0.940.87999999999Percent of total billed charges0.780.721999999999Percent of total billed charges0.780.98
LEVOTHYROXINE TAB [50 MCG]2500073CDM250RCboth1.080.760.920.85999999999 Percent of total billed charges0.980.91999999999 Percent of total billed charges0.840.78999999999Percent of total billed charges0.810.75999999999Percent of total billed charges0.940.87999999999Percent of total billed charges0.780.721999999999Percent of total billed charges0.780.98
ONDANSETRON INJ [2 MG/ML]2500284CDM250RCboth1.110.780.940.85999999999 Percent of total billed charges1.010.91999999999 Percent of total billed charges0.870.78999999999Percent of total billed charges0.830.75999999999Percent of total billed charges0.970.87999999999Percent of total billed charges0.80.721999999999Percent of total billed charges0.81.01
LEVOTHYROXINE 25 MCG2500525CDM250RCboth1.120.780.950.85999999999 Percent of total billed charges1.020.91999999999 Percent of total billed charges0.870.78999999999Percent of total billed charges0.840.75999999999Percent of total billed charges0.970.87999999999Percent of total billed charges0.810.721999999999Percent of total billed charges0.811.02
METOPROLOL TAR TAB [50 MG]2500096CDM250RCboth1.140.80.970.85999999999 Percent of total billed charges1.040.91999999999 Percent of total billed charges0.890.78999999999Percent of total billed charges0.860.75999999999Percent of total billed charges0.990.87999999999Percent of total billed charges0.820.721999999999Percent of total billed charges0.821.04
Mucinex 600 mg2500483CDM250RCboth1.140.80.970.85999999999 Percent of total billed charges1.040.91999999999 Percent of total billed charges0.890.78999999999Percent of total billed charges0.860.75999999999Percent of total billed charges0.990.87999999999Percent of total billed charges0.820.721999999999Percent of total billed charges0.821.04
ACETAMINOPHEN SUPP 120 MG2500473CDM250RCboth1.160.810.990.85999999999 Percent of total billed charges1.060.91999999999 Percent of total billed charges0.90.78999999999Percent of total billed charges0.870.75999999999Percent of total billed charges1.010.87999999999Percent of total billed charges0.840.721999999999Percent of total billed charges0.841.06
GABAPENTIN CAP [100 MG]2500052CDM250RCboth1.170.820.990.85999999999 Percent of total billed charges1.060.91999999999 Percent of total billed charges0.910.78999999999Percent of total billed charges0.880.75999999999Percent of total billed charges1.020.87999999999Percent of total billed charges0.840.721999999999Percent of total billed charges0.841.06
Carbidopa-Levodopa Tab. 25-100 MG2500023CDM250RCboth1.190.831.010.85999999999 Percent of total billed charges1.080.91999999999 Percent of total billed charges0.930.78999999999Percent of total billed charges0.890.75999999999Percent of total billed charges1.040.87999999999Percent of total billed charges0.860.721999999999Percent of total billed charges0.861.08
LEVOTHYROXINE TAB [75 MCG]2500074CDM250RCboth1.20.841.020.85999999999 Percent of total billed charges1.090.91999999999 Percent of total billed charges0.940.78999999999Percent of total billed charges0.90.75999999999Percent of total billed charges1.040.87999999999Percent of total billed charges0.870.721999999999Percent of total billed charges0.871.09
AMIODARONE HCL 200 MG2500005CDM250RCboth1.210.851.030.85999999999 Percent of total billed charges1.10.91999999999 Percent of total billed charges0.940.78999999999Percent of total billed charges0.910.75999999999Percent of total billed charges1.050.87999999999Percent of total billed charges0.870.721999999999Percent of total billed charges0.871.1
LEVOTHYROXINE TAB [100 MCG]2500076CDM250RCboth1.220.851.040.85999999999 Percent of total billed charges1.110.91999999999 Percent of total billed charges0.950.78999999999Percent of total billed charges0.920.75999999999Percent of total billed charges1.060.87999999999Percent of total billed charges0.880.721999999999Percent of total billed charges0.881.11
LEVOTHYROXINE TAB [88 MCG]2500075CDM250RCboth1.220.851.040.85999999999 Percent of total billed charges1.110.91999999999 Percent of total billed charges0.950.78999999999Percent of total billed charges0.920.75999999999Percent of total billed charges1.060.87999999999Percent of total billed charges0.880.721999999999Percent of total billed charges0.881.11
POTASSIUM CL TAB [10 MEQ]2500111CDM250RCboth1.220.851.040.85999999999 Percent of total billed charges1.110.91999999999 Percent of total billed charges0.950.78999999999Percent of total billed charges0.920.75999999999Percent of total billed charges1.060.87999999999Percent of total billed charges0.880.721999999999Percent of total billed charges0.881.11
ACETAMINOPHEN-CODEINE TAB2500009CDM250RCboth1.220.851.040.85999999999 Percent of total billed charges1.110.91999999999 Percent of total billed charges0.950.78999999999Percent of total billed charges0.920.75999999999Percent of total billed charges1.060.87999999999Percent of total billed charges0.880.721999999999Percent of total billed charges0.881.11
CHLORDIAZEPOXIDE CAP [10 MG2500344CDM250RCboth1.240.871.050.85999999999 Percent of total billed charges1.130.91999999999 Percent of total billed charges0.970.78999999999Percent of total billed charges0.930.75999999999Percent of total billed charges1.080.87999999999Percent of total billed charges0.890.721999999999Percent of total billed charges0.891.13
NACL 0.9% FLUSH 10 ML2500449CDM250RCboth1.240.871.050.85999999999 Percent of total billed charges1.130.91999999999 Percent of total billed charges0.970.78999999999Percent of total billed charges0.930.75999999999Percent of total billed charges1.080.87999999999Percent of total billed charges0.890.721999999999Percent of total billed charges0.891.13
CLINDAMYCIN CAP [150 MG]2500164CDM250RCboth1.250.881.060.85999999999 Percent of total billed charges1.140.91999999999 Percent of total billed charges0.980.78999999999Percent of total billed charges0.940.75999999999Percent of total billed charges1.090.87999999999Percent of total billed charges0.90.721999999999Percent of total billed charges0.91.14
Atorvastatin Calcium Tab 10 MG2500017CDM250RCboth1.260.881.070.85999999999 Percent of total billed charges1.150.91999999999 Percent of total billed charges0.980.78999999999Percent of total billed charges0.950.75999999999Percent of total billed charges1.10.87999999999Percent of total billed charges0.910.721999999999Percent of total billed charges0.911.15
ISOSORBIDE 20 MG2500501CDM250RCboth1.270.891.080.85999999999 Percent of total billed charges1.160.91999999999 Percent of total billed charges0.990.78999999999Percent of total billed charges0.950.75999999999Percent of total billed charges1.10.87999999999Percent of total billed charges0.920.721999999999Percent of total billed charges0.921.16
PROBIOTIC CAP2500153CDM250RCboth1.280.91.090.85999999999 Percent of total billed charges1.160.91999999999 Percent of total billed charges10.78999999999Percent of total billed charges0.960.75999999999Percent of total billed charges1.110.87999999999Percent of total billed charges0.920.721999999999Percent of total billed charges0.921.16
WARFARIN TAB [5 MG]2500146CDM250RCboth1.290.91.10.85999999999 Percent of total billed charges1.170.91999999999 Percent of total billed charges1.010.78999999999Percent of total billed charges0.970.75999999999Percent of total billed charges1.120.87999999999Percent of total billed charges0.930.721999999999Percent of total billed charges0.931.17
ACETAMINOPHEN SUPP 325 MG2500006CDM250RCboth1.310.921.110.85999999999 Percent of total billed charges1.190.91999999999 Percent of total billed charges1.020.78999999999Percent of total billed charges0.980.75999999999Percent of total billed charges1.140.87999999999Percent of total billed charges0.940.721999999999Percent of total billed charges0.941.19
WARFARIN TAB [3 MG]2500144CDM250RCboth1.310.921.110.85999999999 Percent of total billed charges1.190.91999999999 Percent of total billed charges1.020.78999999999Percent of total billed charges0.980.75999999999Percent of total billed charges1.140.87999999999Percent of total billed charges0.940.721999999999Percent of total billed charges0.941.19
DICYCLOMINE CAP [10MG]2500032CDM250RCboth1.320.921.120.85999999999 Percent of total billed charges1.20.91999999999 Percent of total billed charges1.030.78999999999Percent of total billed charges0.990.75999999999Percent of total billed charges1.150.87999999999Percent of total billed charges0.950.721999999999Percent of total billed charges0.951.2
ACETAMINOPHEN SUPP ADULT [650 MG]2500035CDM250RCboth1.330.931.130.85999999999 Percent of total billed charges1.210.91999999999 Percent of total billed charges1.040.78999999999Percent of total billed charges10.75999999999Percent of total billed charges1.160.87999999999Percent of total billed charges0.960.721999999999Percent of total billed charges0.961.21
CEPHALEXIN CAP [250 MG]2500161CDM250RCboth1.360.951.160.85999999999 Percent of total billed charges1.240.91999999999 Percent of total billed charges1.060.78999999999Percent of total billed charges1.020.75999999999Percent of total billed charges1.180.87999999999Percent of total billed charges0.980.721999999999Percent of total billed charges0.981.24
PHENYTOIN ER CAP [100 MG]2500110CDM250RCboth1.360.951.160.85999999999 Percent of total billed charges1.240.91999999999 Percent of total billed charges1.060.78999999999Percent of total billed charges1.020.75999999999Percent of total billed charges1.180.87999999999Percent of total billed charges0.980.721999999999Percent of total billed charges0.981.24
HYDROCODONE/APAP TAB [5-325 MG]2500326CDM250RCboth1.380.971.170.85999999999 Percent of total billed charges1.260.91999999999 Percent of total billed charges1.080.78999999999Percent of total billed charges1.040.75999999999Percent of total billed charges1.20.87999999999Percent of total billed charges0.990.721999999999Percent of total billed charges0.991.26
LOMOTIL TAB [2.5 MG/0.025 MG]2500469CDM250RCboth1.40.981.190.85999999999 Percent of total billed charges1.270.91999999999 Percent of total billed charges1.090.78999999999Percent of total billed charges1.050.75999999999Percent of total billed charges1.220.87999999999Percent of total billed charges1.010.721999999999Percent of total billed charges1.011.27
LORATADINE TAB [10 MG]2500082CDM250RCboth1.40.981.190.85999999999 Percent of total billed charges1.270.91999999999 Percent of total billed charges1.090.78999999999Percent of total billed charges1.050.75999999999Percent of total billed charges1.220.87999999999Percent of total billed charges1.010.721999999999Percent of total billed charges1.011.27
MECLIZINE TAB [12.5 MG]2500085CDM250RCboth1.40.981.190.85999999999 Percent of total billed charges1.270.91999999999 Percent of total billed charges1.090.78999999999Percent of total billed charges1.050.75999999999Percent of total billed charges1.220.87999999999Percent of total billed charges1.010.721999999999Percent of total billed charges1.011.27
METFORMIN TAB [500 MG]2500088CDM250RCboth1.40.981.190.85999999999 Percent of total billed charges1.270.91999999999 Percent of total billed charges1.090.78999999999Percent of total billed charges1.050.75999999999Percent of total billed charges1.220.87999999999Percent of total billed charges1.010.721999999999Percent of total billed charges1.011.27
LEVOTHYROXINE TAB [112 MCG]2500077CDM250RCboth1.420.991.210.85999999999 Percent of total billed charges1.290.91999999999 Percent of total billed charges1.110.78999999999Percent of total billed charges1.070.75999999999Percent of total billed charges1.240.87999999999Percent of total billed charges1.020.721999999999Percent of total billed charges1.021.29
LEVOTHYROXINE TAB [125 MCG]2500078CDM250RCboth1.441.011.220.85999999999 Percent of total billed charges1.310.91999999999 Percent of total billed charges1.120.78999999999Percent of total billed charges1.080.75999999999Percent of total billed charges1.250.87999999999Percent of total billed charges1.040.721999999999Percent of total billed charges1.041.31
VITAMIN D CAP [1.25MG-50,000UT]2500378CDM250RCboth1.441.011.220.85999999999 Percent of total billed charges1.310.91999999999 Percent of total billed charges1.120.78999999999Percent of total billed charges1.080.75999999999Percent of total billed charges1.250.87999999999Percent of total billed charges1.040.721999999999Percent of total billed charges1.041.31
BENZONATATE CAP 100 MG2500413CDM250RCboth1.461.021.240.85999999999 Percent of total billed charges1.330.91999999999 Percent of total billed charges1.140.78999999999Percent of total billed charges1.10.75999999999Percent of total billed charges1.270.87999999999Percent of total billed charges1.050.721999999999Percent of total billed charges1.051.33
Baclofen Oral Tablet 10 MG2500018CDM250RCboth1.481.041.260.85999999999 Percent of total billed charges1.350.91999999999 Percent of total billed charges1.150.78999999999Percent of total billed charges1.110.75999999999Percent of total billed charges1.290.87999999999Percent of total billed charges1.070.721999999999Percent of total billed charges1.071.35
ONDANSETRON TAB [4 MG]2500102CDM250RCboth1.491.041.270.85999999999 Percent of total billed charges1.360.91999999999 Percent of total billed charges1.160.78999999999Percent of total billed charges1.120.75999999999Percent of total billed charges1.30.87999999999Percent of total billed charges1.070.721999999999Percent of total billed charges1.071.36
CLONAZEPAM TAB [0.5 MG]2500346CDM250RCboth1.51.051.280.85999999999 Percent of total billed charges1.370.91999999999 Percent of total billed charges1.170.78999999999Percent of total billed charges1.130.75999999999Percent of total billed charges1.310.87999999999Percent of total billed charges1.080.721999999999Percent of total billed charges1.081.37
FLUDROCORTISONE TAB [0.1 MG]2500047CDM250RCboth1.51.051.280.85999999999 Percent of total billed charges1.370.91999999999 Percent of total billed charges1.170.78999999999Percent of total billed charges1.130.75999999999Percent of total billed charges1.310.87999999999Percent of total billed charges1.080.721999999999Percent of total billed charges1.081.37
MORPHINE ORAL SOL [20 MG/ML]2500337CDM250RCboth1.51.051.280.85999999999 Percent of total billed charges1.370.91999999999 Percent of total billed charges1.170.78999999999Percent of total billed charges1.130.75999999999Percent of total billed charges1.310.87999999999Percent of total billed charges1.080.721999999999Percent of total billed charges1.081.37
HYDROCODONE/APAP TAB [7.5-325 MG]2500327CDM250RCboth1.541.081.310.85999999999 Percent of total billed charges1.40.91999999999 Percent of total billed charges1.20.78999999999Percent of total billed charges1.160.75999999999Percent of total billed charges1.340.87999999999Percent of total billed charges1.110.721999999999Percent of total billed charges1.111.4
DONEPEZIL TAB [10 MG]2500037CDM250RCboth1.551.091.320.85999999999 Percent of total billed charges1.410.91999999999 Percent of total billed charges1.210.78999999999Percent of total billed charges1.160.75999999999Percent of total billed charges1.350.87999999999Percent of total billed charges1.120.721999999999Percent of total billed charges1.121.41
PHENYTOIN SUSP [125 MG/5 ML]2500224CDM250RCboth1.561.091.330.85999999999 Percent of total billed charges1.420.91999999999 Percent of total billed charges1.220.78999999999Percent of total billed charges1.170.75999999999Percent of total billed charges1.360.87999999999Percent of total billed charges1.120.721999999999Percent of total billed charges1.121.42
TRAMADOL TAB [50 MG]2500354CDM250RCboth1.591.111.350.85999999999 Percent of total billed charges1.450.91999999999 Percent of total billed charges1.240.78999999999Percent of total billed charges1.190.75999999999Percent of total billed charges1.380.87999999999Percent of total billed charges1.150.721999999999Percent of total billed charges1.151.45
Atenolol 25 mg.2500016CDM250RCboth1.61.121.360.85999999999 Percent of total billed charges1.460.91999999999 Percent of total billed charges1.250.78999999999Percent of total billed charges1.20.75999999999Percent of total billed charges1.390.87999999999Percent of total billed charges1.150.721999999999Percent of total billed charges1.151.46
DICLOFENAC TAB [75 MG]2500033CDM250RCboth1.61.121.360.85999999999 Percent of total billed charges1.460.91999999999 Percent of total billed charges1.250.78999999999Percent of total billed charges1.20.75999999999Percent of total billed charges1.390.87999999999Percent of total billed charges1.150.721999999999Percent of total billed charges1.151.46
MEMANTINE TAB [10 MG]2500086CDM250RCboth1.61.121.360.85999999999 Percent of total billed charges1.460.91999999999 Percent of total billed charges1.250.78999999999Percent of total billed charges1.20.75999999999Percent of total billed charges1.390.87999999999Percent of total billed charges1.150.721999999999Percent of total billed charges1.151.46
POTASSIUM CL TAB [20 MEQ]2500112CDM250RCboth1.61.121.360.85999999999 Percent of total billed charges1.460.91999999999 Percent of total billed charges1.250.78999999999Percent of total billed charges1.20.75999999999Percent of total billed charges1.390.87999999999Percent of total billed charges1.150.721999999999Percent of total billed charges1.151.46
INS - HUMULIN 70/30 MIX [1 UNITS/0.01 ML2500433CDM250RCboth1.651.161.40.85999999999 Percent of total billed charges1.50.91999999999 Percent of total billed charges1.290.78999999999Percent of total billed charges1.240.75999999999Percent of total billed charges1.440.87999999999Percent of total billed charges1.190.721999999999Percent of total billed charges1.191.5
NOVOLIN N2500434CDM250RCboth1.651.161.40.85999999999 Percent of total billed charges1.50.91999999999 Percent of total billed charges1.290.78999999999Percent of total billed charges1.240.75999999999Percent of total billed charges1.440.87999999999Percent of total billed charges1.190.721999999999Percent of total billed charges1.191.5
NOVOLIN R2500440CDM250RCboth1.651.161.40.85999999999 Percent of total billed charges1.50.91999999999 Percent of total billed charges1.290.78999999999Percent of total billed charges1.240.75999999999Percent of total billed charges1.440.87999999999Percent of total billed charges1.190.721999999999Percent of total billed charges1.191.5
TORSEMIDE TAB [20 MG]2500137CDM250RCboth1.661.161.410.85999999999 Percent of total billed charges1.510.91999999999 Percent of total billed charges1.290.78999999999Percent of total billed charges1.250.75999999999Percent of total billed charges1.440.87999999999Percent of total billed charges1.20.721999999999Percent of total billed charges1.21.51
DOXEPIN CAP [25 MG]2500043CDM250RCboth1.681.181.430.85999999999 Percent of total billed charges1.530.91999999999 Percent of total billed charges1.310.78999999999Percent of total billed charges1.260.75999999999Percent of total billed charges1.460.87999999999Percent of total billed charges1.210.721999999999Percent of total billed charges1.211.53
HYOSCYAMINE TAB [0.125 MG]2500065CDM250RCboth1.71.191.450.85999999999 Percent of total billed charges1.550.91999999999 Percent of total billed charges1.330.78999999999Percent of total billed charges1.280.75999999999Percent of total billed charges1.480.87999999999Percent of total billed charges1.230.721999999999Percent of total billed charges1.231.55
LISINOPRIL TAB [5 MG]2500080CDM250RCboth1.741.221.480.85999999999 Percent of total billed charges1.580.91999999999 Percent of total billed charges1.360.78999999999Percent of total billed charges1.310.75999999999Percent of total billed charges1.510.87999999999Percent of total billed charges1.250.721999999999Percent of total billed charges1.251.58
GLIMEPIRIDE TAB [2 MG]2500054CDM250RCboth1.761.231.50.85999999999 Percent of total billed charges1.60.91999999999 Percent of total billed charges1.370.78999999999Percent of total billed charges1.320.75999999999Percent of total billed charges1.530.87999999999Percent of total billed charges1.270.721999999999Percent of total billed charges1.271.6
CLINDAMYCIN INJ [600 MG/4 ML]2500238CDM250RCboth1.771.241.50.85999999999 Percent of total billed charges1.610.91999999999 Percent of total billed charges1.380.78999999999Percent of total billed charges1.330.75999999999Percent of total billed charges1.540.87999999999Percent of total billed charges1.280.721999999999Percent of total billed charges1.281.61
HUMULIN R INJ [1 UNITS/0.01 ML]2500438CDM250RCboth1.781.251.510.85999999999 Percent of total billed charges1.620.91999999999 Percent of total billed charges1.390.78999999999Percent of total billed charges1.340.75999999999Percent of total billed charges1.550.87999999999Percent of total billed charges1.280.721999999999Percent of total billed charges1.281.62
PROCHLORPERAZINE TAB [10 MG]2500116CDM250RCboth1.781.251.510.85999999999 Percent of total billed charges1.620.91999999999 Percent of total billed charges1.390.78999999999Percent of total billed charges1.340.75999999999Percent of total billed charges1.550.87999999999Percent of total billed charges1.280.721999999999Percent of total billed charges1.281.62
SILVER NITRATE120671CDM250RCboth1.811.271.540.85999999999 Percent of total billed charges1.650.91999999999 Percent of total billed charges1.410.78999999999Percent of total billed charges1.360.75999999999Percent of total billed charges1.570.87999999999Percent of total billed charges1.310.721999999999Percent of total billed charges1.311.65
HYDROXYZINE TAB [25 MG]2500064CDM250RCboth1.841.291.560.85999999999 Percent of total billed charges1.670.91999999999 Percent of total billed charges1.440.78999999999Percent of total billed charges1.380.75999999999Percent of total billed charges1.60.87999999999Percent of total billed charges1.330.721999999999Percent of total billed charges1.331.67
METRONIDAZOLE TABLET [500 MG]2500168CDM250RCboth1.841.291.560.85999999999 Percent of total billed charges1.670.91999999999 Percent of total billed charges1.440.78999999999Percent of total billed charges1.380.75999999999Percent of total billed charges1.60.87999999999Percent of total billed charges1.330.721999999999Percent of total billed charges1.331.67
IBUPROFEN LIQ [100 MG/5 ML]2500220CDM250RCboth1.881.321.60.85999999999 Percent of total billed charges1.710.91999999999 Percent of total billed charges1.470.78999999999Percent of total billed charges1.410.75999999999Percent of total billed charges1.640.87999999999Percent of total billed charges1.360.721999999999Percent of total billed charges1.361.71
KETOROLAC INJ [15 MG/1 ML]2500266CDM250RCboth1.91.331.620.85999999999 Percent of total billed charges1.730.91999999999 Percent of total billed charges1.480.78999999999Percent of total billed charges1.430.75999999999Percent of total billed charges1.650.87999999999Percent of total billed charges1.370.721999999999Percent of total billed charges1.371.73
PROMETHAZINE TAB [25 MG]2500117CDM250RCboth1.91.331.620.85999999999 Percent of total billed charges1.730.91999999999 Percent of total billed charges1.480.78999999999Percent of total billed charges1.430.75999999999Percent of total billed charges1.650.87999999999Percent of total billed charges1.370.721999999999Percent of total billed charges1.371.73
ALPRAZOLAM TAB [0.5 MG]2500342CDM250RCboth1.921.341.630.85999999999 Percent of total billed charges1.750.91999999999 Percent of total billed charges1.50.78999999999Percent of total billed charges1.440.75999999999Percent of total billed charges1.670.87999999999Percent of total billed charges1.380.721999999999Percent of total billed charges1.381.75
METOCLOPRAMIDE TAB [10 MG]2500091CDM250RCboth1.921.341.630.85999999999 Percent of total billed charges1.750.91999999999 Percent of total billed charges1.50.78999999999Percent of total billed charges1.440.75999999999Percent of total billed charges1.670.87999999999Percent of total billed charges1.380.721999999999Percent of total billed charges1.381.75
DILTIAZEM CD CAP [180 MG]2500039CDM250RCboth1.941.361.650.85999999999 Percent of total billed charges1.770.91999999999 Percent of total billed charges1.510.78999999999Percent of total billed charges1.460.75999999999Percent of total billed charges1.690.87999999999Percent of total billed charges1.40.721999999999Percent of total billed charges1.41.77
ACETAMINOPHEN SUSP 160MG/5ML121878CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
AMOXIL 400MG/5ML SUSP121663CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
AMPHOJEL 30CC120051CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
ASPIRIN TAB 325MG120077CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
BACLOFEN 10MG TAB121389CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
CARAFATE ORAL SUSP 1GM/10ML121396CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
CITALOPRAM 10MG TAB121398CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
DICYCLOMINE 10MG CAP121298CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
DIPHENHYDRAMINE ORAL SOL 12.5MG/5ML121510CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
GLYCERIN SUPP120382CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
GUAIFENESIN 100MG/5ML120654CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
IBUPROPHEN SUSP/5CC120980CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
IBUPROPHEN/MOTRIN 200MG121191CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
LACTULOSE 10MG/15ML121197CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
MICRO K TAB. 10 MEQ120504CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
MILK OF MAGNESIA 30CC120505CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
MYLANTA 30ML.120522CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
TUSSIONEX SUSP. 5 ML.120804CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
VITAMIN C 500MG121288CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
TRIPLE ANTIBIOTIC OINT120539CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
CHILDRENS ACETAMINOPHEN2500007CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
Midazolam 0.5mg/ml2500581CDM250RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
LOPERAMIDE CAP [2 MG]2500083CDM250RCboth2.041.431.730.85999999999 Percent of total billed charges1.860.91999999999 Percent of total billed charges1.590.78999999999Percent of total billed charges1.530.75999999999Percent of total billed charges1.770.87999999999Percent of total billed charges1.470.721999999999Percent of total billed charges1.471.86
NITROGLYCERIN SL TAB [0.4 MG]2500100CDM250RCboth2.051.441.740.85999999999 Percent of total billed charges1.870.91999999999 Percent of total billed charges1.60.78999999999Percent of total billed charges1.540.75999999999Percent of total billed charges1.780.87999999999Percent of total billed charges1.480.721999999999Percent of total billed charges1.481.87
MIRTAZAPINE TAB [15 MG]2500377CDM250RCboth2.081.461.770.85999999999 Percent of total billed charges1.890.91999999999 Percent of total billed charges1.620.78999999999Percent of total billed charges1.560.75999999999Percent of total billed charges1.810.87999999999Percent of total billed charges1.50.721999999999Percent of total billed charges1.51.89
KETOROLAC INJ [30 MG/ML]2500265CDM250RCboth2.091.461.780.85999999999 Percent of total billed charges1.90.91999999999 Percent of total billed charges1.630.78999999999Percent of total billed charges1.570.75999999999Percent of total billed charges1.820.87999999999Percent of total billed charges1.510.721999999999Percent of total billed charges1.511.9
VALPROIC ACID LIQ [250 MG/5 ML]2500461CDM250RCboth2.11.471.790.85999999999 Percent of total billed charges1.910.91999999999 Percent of total billed charges1.640.78999999999Percent of total billed charges1.580.75999999999Percent of total billed charges1.830.87999999999Percent of total billed charges1.510.721999999999Percent of total billed charges1.511.91
FUROSEMIDE INJ 20MG/2 ML]2500255CDM250RCboth2.161.511.840.85999999999 Percent of total billed charges1.970.91999999999 Percent of total billed charges1.680.78999999999Percent of total billed charges1.620.75999999999Percent of total billed charges1.880.87999999999Percent of total billed charges1.560.721999999999Percent of total billed charges1.561.97
LIDOCAINE VISCOUS 2% 15ML2500001CDM250RCboth2.161.511.840.85999999999 Percent of total billed charges1.970.91999999999 Percent of total billed charges1.680.78999999999Percent of total billed charges1.620.75999999999Percent of total billed charges1.880.87999999999Percent of total billed charges1.560.721999999999Percent of total billed charges1.561.97
HYDROCORTISONE TAB [20 MG]2500062CDM250RCboth2.171.521.840.85999999999 Percent of total billed charges1.970.91999999999 Percent of total billed charges1.690.78999999999Percent of total billed charges1.630.75999999999Percent of total billed charges1.890.87999999999Percent of total billed charges1.560.721999999999Percent of total billed charges1.561.97
HYDROCODONE/APAP TAB [10-325 MG]2500328CDM250RCboth2.21.541.870.85999999999 Percent of total billed charges20.91999999999 Percent of total billed charges1.720.78999999999Percent of total billed charges1.650.75999999999Percent of total billed charges1.910.87999999999Percent of total billed charges1.590.721999999999Percent of total billed charges1.592
METOPROLOL SUCC ER TAB [50 MG]2500095CDM250RCboth2.231.561.90.85999999999 Percent of total billed charges2.030.91999999999 Percent of total billed charges1.740.78999999999Percent of total billed charges1.670.75999999999Percent of total billed charges1.940.87999999999Percent of total billed charges1.610.721999999999Percent of total billed charges1.612.03
METOPROLOL SUCC ER TAB 25 MG2500414CDM250RCboth2.231.561.90.85999999999 Percent of total billed charges2.030.91999999999 Percent of total billed charges1.740.78999999999Percent of total billed charges1.670.75999999999Percent of total billed charges1.940.87999999999Percent of total billed charges1.610.721999999999Percent of total billed charges1.612.03
SODIUM CHLORIDE INJ 0.9%2500531CDM250RCboth2.261.581.920.85999999999 Percent of total billed charges2.060.91999999999 Percent of total billed charges1.760.78999999999Percent of total billed charges1.70.75999999999Percent of total billed charges1.970.87999999999Percent of total billed charges1.630.721999999999Percent of total billed charges1.632.06
SODIUM CHLORIDE BACTERIOS INJ 0.9% [10 M2500303CDM250RCboth2.261.581.920.85999999999 Percent of total billed charges2.060.91999999999 Percent of total billed charges1.760.78999999999Percent of total billed charges1.70.75999999999Percent of total billed charges1.970.87999999999Percent of total billed charges1.630.721999999999Percent of total billed charges1.632.06
FAMOTIDINE INJ [20 MG/2 ML]2500424CDM250RCboth2.281.61.940.85999999999 Percent of total billed charges2.070.91999999999 Percent of total billed charges1.780.78999999999Percent of total billed charges1.710.75999999999Percent of total billed charges1.980.87999999999Percent of total billed charges1.640.721999999999Percent of total billed charges1.642.07
CEFTRIAXONE **IVPB** 500 MG/NS 50 ML2500399CDM250RCboth2.321.621.970.85999999999 Percent of total billed charges2.110.91999999999 Percent of total billed charges1.810.78999999999Percent of total billed charges1.740.75999999999Percent of total billed charges2.020.87999999999Percent of total billed charges1.670.721999999999Percent of total billed charges1.672.11
cefTRIAXone INJ [500 MG]250036CDM250RCboth2.321.621.970.85999999999 Percent of total billed charges2.110.91999999999 Percent of total billed charges1.810.78999999999Percent of total billed charges1.740.75999999999Percent of total billed charges2.020.87999999999Percent of total billed charges1.670.721999999999Percent of total billed charges1.672.11
DEXAMETHASONE 4MG TAB2500545CDM250RCboth2.381.672.020.85999999999 Percent of total billed charges2.170.91999999999 Percent of total billed charges1.860.78999999999Percent of total billed charges1.790.75999999999Percent of total billed charges2.070.87999999999Percent of total billed charges1.720.721999999999Percent of total billed charges1.722.17
CEFTRIAXONE **IVPB** 250 MG/NS 50 ML2500398CDM250RCboth2.41.682.040.85999999999 Percent of total billed charges2.180.91999999999 Percent of total billed charges1.870.78999999999Percent of total billed charges1.80.75999999999Percent of total billed charges2.090.87999999999Percent of total billed charges1.730.721999999999Percent of total billed charges1.732.18
cefTRIAXone INJ [250 MG]2500235CDM250RCboth2.41.682.040.85999999999 Percent of total billed charges2.180.91999999999 Percent of total billed charges1.870.78999999999Percent of total billed charges1.80.75999999999Percent of total billed charges2.090.87999999999Percent of total billed charges1.730.721999999999Percent of total billed charges1.732.18
CHLORTHALIDONE TAB [25 MG]2500375CDM250RCboth2.411.692.050.85999999999 Percent of total billed charges2.190.91999999999 Percent of total billed charges1.880.78999999999Percent of total billed charges1.810.75999999999Percent of total billed charges2.10.87999999999Percent of total billed charges1.740.721999999999Percent of total billed charges1.742.19
NIFEDIPINE ER TAB [30 MG]2500099CDM250RCboth2.651.862.250.85999999999 Percent of total billed charges2.410.91999999999 Percent of total billed charges2.070.78999999999Percent of total billed charges1.990.75999999999Percent of total billed charges2.310.87999999999Percent of total billed charges1.910.721999999999Percent of total billed charges1.912.41
NAPROXEN TAB [500 MG]2500098CDM250RCboth2.681.882.280.85999999999 Percent of total billed charges2.440.91999999999 Percent of total billed charges2.090.78999999999Percent of total billed charges2.010.75999999999Percent of total billed charges2.330.87999999999Percent of total billed charges1.930.721999999999Percent of total billed charges1.932.44
LACTULOSE LIQ [10 GM/15 ML]2500462CDM250RCboth2.71.892.30.85999999999 Percent of total billed charges2.460.91999999999 Percent of total billed charges2.110.78999999999Percent of total billed charges2.030.75999999999Percent of total billed charges2.350.87999999999Percent of total billed charges1.950.721999999999Percent of total billed charges1.952.46
OXYCODONE/ ACET TAB [5-325 MG]2500332CDM250RCboth2.741.922.330.85999999999 Percent of total billed charges2.490.91999999999 Percent of total billed charges2.140.78999999999Percent of total billed charges2.060.75999999999Percent of total billed charges2.380.87999999999Percent of total billed charges1.980.721999999999Percent of total billed charges1.982.49
GABAPENTIN CAP [300 MG]2500053CDM250RCboth2.751.932.340.85999999999 Percent of total billed charges2.50.91999999999 Percent of total billed charges2.150.78999999999Percent of total billed charges2.060.75999999999Percent of total billed charges2.390.87999999999Percent of total billed charges1.980.721999999999Percent of total billed charges1.982.5
METOPROLOL INJ [5 MG/5 ML]2500280CDM250RCboth2.821.972.40.85999999999 Percent of total billed charges2.570.91999999999 Percent of total billed charges2.20.78999999999Percent of total billed charges2.120.75999999999Percent of total billed charges2.450.87999999999Percent of total billed charges2.030.721999999999Percent of total billed charges2.032.57
DIVALPROEX SODIUM DR [500mg]2500041CDM250RCboth2.841.992.410.85999999999 Percent of total billed charges2.580.91999999999 Percent of total billed charges2.220.78999999999Percent of total billed charges2.130.75999999999Percent of total billed charges2.470.87999999999Percent of total billed charges2.050.721999999999Percent of total billed charges2.052.58
METOCLOPRAMIDE INJ [5 MG/ML]2500279CDM250RCboth2.841.992.410.85999999999 Percent of total billed charges2.580.91999999999 Percent of total billed charges2.220.78999999999Percent of total billed charges2.130.75999999999Percent of total billed charges2.470.87999999999Percent of total billed charges2.050.721999999999Percent of total billed charges2.052.58
BENZTROPINE 2MG TAB121402CDM250RCboth32.12.550.85999999999 Percent of total billed charges2.730.91999999999 Percent of total billed charges2.340.78999999999Percent of total billed charges2.250.75999999999Percent of total billed charges2.610.87999999999Percent of total billed charges2.160.721999999999Percent of total billed charges2.162.73
MIRALAX 17GM121452CDM250RCboth32.12.550.85999999999 Percent of total billed charges2.730.91999999999 Percent of total billed charges2.340.78999999999Percent of total billed charges2.250.75999999999Percent of total billed charges2.610.87999999999Percent of total billed charges2.160.721999999999Percent of total billed charges2.162.73
NORVASC 2.5MG TAB121253CDM250RCboth32.12.550.85999999999 Percent of total billed charges2.730.91999999999 Percent of total billed charges2.340.78999999999Percent of total billed charges2.250.75999999999Percent of total billed charges2.610.87999999999Percent of total billed charges2.160.721999999999Percent of total billed charges2.162.73
SINGULAIR 10MG TAB121490CDM250RCboth32.12.550.85999999999 Percent of total billed charges2.730.91999999999 Percent of total billed charges2.340.78999999999Percent of total billed charges2.250.75999999999Percent of total billed charges2.610.87999999999Percent of total billed charges2.160.721999999999Percent of total billed charges2.162.73
TYLENOL SUPP 325MG120005CDM250RCboth32.12.550.85999999999 Percent of total billed charges2.730.91999999999 Percent of total billed charges2.340.78999999999Percent of total billed charges2.250.75999999999Percent of total billed charges2.610.87999999999Percent of total billed charges2.160.721999999999Percent of total billed charges2.162.73
TYLENOL SUPP 650MG120006CDM250RCboth32.12.550.85999999999 Percent of total billed charges2.730.91999999999 Percent of total billed charges2.340.78999999999Percent of total billed charges2.250.75999999999Percent of total billed charges2.610.87999999999Percent of total billed charges2.160.721999999999Percent of total billed charges2.162.73
NYSTATIN SUSP2500202CDM250RCboth3.082.162.620.85999999999 Percent of total billed charges2.80.91999999999 Percent of total billed charges2.40.78999999999Percent of total billed charges2.310.75999999999Percent of total billed charges2.680.87999999999Percent of total billed charges2.220.721999999999Percent of total billed charges2.222.8
INDAPAMIDE TAB [2.5 MG]2500068CDM250RCboth3.12.172.640.85999999999 Percent of total billed charges2.820.91999999999 Percent of total billed charges2.420.78999999999Percent of total billed charges2.330.75999999999Percent of total billed charges2.70.87999999999Percent of total billed charges2.240.721999999999Percent of total billed charges2.242.82
LORazepam Injection Solution 2 MG/ML2500521CDM250RCboth3.12.172.640.85999999999 Percent of total billed charges2.820.91999999999 Percent of total billed charges2.420.78999999999Percent of total billed charges2.330.75999999999Percent of total billed charges2.70.87999999999Percent of total billed charges2.240.721999999999Percent of total billed charges2.242.82
TERAZOSIN CAP [1 MG]2500133CDM250RCboth3.212.252.730.85999999999 Percent of total billed charges2.920.91999999999 Percent of total billed charges2.50.78999999999Percent of total billed charges2.410.75999999999Percent of total billed charges2.790.87999999999Percent of total billed charges2.310.721999999999Percent of total billed charges2.312.92
VERAPAMIL ER TAB [240 MG]2500141CDM250RCboth3.272.292.780.85999999999 Percent of total billed charges2.980.91999999999 Percent of total billed charges2.550.78999999999Percent of total billed charges2.450.75999999999Percent of total billed charges2.840.87999999999Percent of total billed charges2.360.721999999999Percent of total billed charges2.362.98
Polyethylene Glycol Powder 17gm2500452CDM250RCboth3.282.32.790.85999999999 Percent of total billed charges2.980.91999999999 Percent of total billed charges2.560.78999999999Percent of total billed charges2.460.75999999999Percent of total billed charges2.850.87999999999Percent of total billed charges2.360.721999999999Percent of total billed charges2.362.98
amLODIPine Besylate oral tablet 5 mg2500013CDM250RCboth3.292.32.80.85999999999 Percent of total billed charges2.990.91999999999 Percent of total billed charges2.570.78999999999Percent of total billed charges2.470.75999999999Percent of total billed charges2.860.87999999999Percent of total billed charges2.370.721999999999Percent of total billed charges2.372.99
ISOSORBIDE MONO ER TAB [30 MG]2500069CDM250RCboth3.292.32.80.85999999999 Percent of total billed charges2.990.91999999999 Percent of total billed charges2.570.78999999999Percent of total billed charges2.470.75999999999Percent of total billed charges2.860.87999999999Percent of total billed charges2.370.721999999999Percent of total billed charges2.372.99
METHYLPREDNISOLONE TAB [4 MG]2500092CDM250RCboth3.32.312.810.85999999999 Percent of total billed charges30.91999999999 Percent of total billed charges2.570.78999999999Percent of total billed charges2.480.75999999999Percent of total billed charges2.870.87999999999Percent of total billed charges2.380.721999999999Percent of total billed charges2.383
BUPROPION SR TAB 100 MG2500021CDM250RCboth3.332.332.830.85999999999 Percent of total billed charges3.030.91999999999 Percent of total billed charges2.60.78999999999Percent of total billed charges2.50.75999999999Percent of total billed charges2.90.87999999999Percent of total billed charges2.40.721999999999Percent of total billed charges2.43.03
MIDAZOLAM INJ [1 MG/ML]2500351CDM250RCboth3.342.342.840.85999999999 Percent of total billed charges3.040.91999999999 Percent of total billed charges2.610.78999999999Percent of total billed charges2.510.75999999999Percent of total billed charges2.910.87999999999Percent of total billed charges2.410.721999999999Percent of total billed charges2.413.04
TIZANIDINE TAB [4 MG]2500134CDM250RCboth3.532.4730.85999999999 Percent of total billed charges3.210.91999999999 Percent of total billed charges2.750.78999999999Percent of total billed charges2.650.75999999999Percent of total billed charges3.070.87999999999Percent of total billed charges2.550.721999999999Percent of total billed charges2.553.21
RACEEPINEPHRINE INH 2.25% [0.5 ML]2500475CDM250RCboth3.62.523.060.85999999999 Percent of total billed charges3.280.91999999999 Percent of total billed charges2.810.78999999999Percent of total billed charges2.70.75999999999Percent of total billed charges3.130.87999999999Percent of total billed charges2.60.721999999999Percent of total billed charges2.63.28
MORPHINE SULFATE ER TAB [15 MG]2500331CDM250RCboth3.692.583.140.85999999999 Percent of total billed charges3.360.91999999999 Percent of total billed charges2.880.78999999999Percent of total billed charges2.770.75999999999Percent of total billed charges3.210.87999999999Percent of total billed charges2.660.721999999999Percent of total billed charges2.663.36
HYDROMORPHONE INJ [2 MG/ML]2500335CDM250RCboth3.762.633.20.85999999999 Percent of total billed charges3.420.91999999999 Percent of total billed charges2.930.78999999999Percent of total billed charges2.820.75999999999Percent of total billed charges3.270.87999999999Percent of total billed charges2.710.721999999999Percent of total billed charges2.713.42
HEPARIN LOCK FLUSH INJ [100 UNITS/ML]2500257CDM250RCboth3.862.73.280.85999999999 Percent of total billed charges3.510.91999999999 Percent of total billed charges3.010.78999999999Percent of total billed charges2.90.75999999999Percent of total billed charges3.360.87999999999Percent of total billed charges2.780.721999999999Percent of total billed charges2.783.51
BUTALBITAL/ACETAMINOPHEN/CAFFEINE [50MG/2500343CDM250RCboth3.92.733.320.85999999999 Percent of total billed charges3.550.91999999999 Percent of total billed charges3.040.78999999999Percent of total billed charges2.930.75999999999Percent of total billed charges3.390.87999999999Percent of total billed charges2.810.721999999999Percent of total billed charges2.813.55
Bumetanide Tab 1 MG2500020CDM250RCboth3.922.743.330.85999999999 Percent of total billed charges3.570.91999999999 Percent of total billed charges3.060.78999999999Percent of total billed charges2.940.75999999999Percent of total billed charges3.410.87999999999Percent of total billed charges2.830.721999999999Percent of total billed charges2.833.57
ACYCLOVIR ORAL TAB 400MG2500010CDM250RCboth3.952.773.360.85999999999 Percent of total billed charges3.590.91999999999 Percent of total billed charges3.080.78999999999Percent of total billed charges2.960.75999999999Percent of total billed charges3.440.87999999999Percent of total billed charges2.850.721999999999Percent of total billed charges2.853.59
ISOSORBIDE MONO ER TAB [60 MG]2500070CDM250RCboth3.992.793.390.85999999999 Percent of total billed charges3.630.91999999999 Percent of total billed charges3.110.78999999999Percent of total billed charges2.990.75999999999Percent of total billed charges3.470.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.63
DULCOLAX SUPP 10MG120231CDM250RCboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.64
FLOMAX 0.4MG121319CDM250RCboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.64
LEVALBUTEROL NEB SOLN [0.63 MG]2500445CDM250RCboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.64
MORPHINE LIQUID121482CDM250RCboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.64
ZYRTEC LIQUID 5MG/5ML121530CDM250RCboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.64
Fentanyl 500mcg/NS 50ml2500582CDM250RCboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.64
BUSPIRONE TAB 15 MG2500022CDM250RCboth4.042.833.430.85999999999 Percent of total billed charges3.680.91999999999 Percent of total billed charges3.150.78999999999Percent of total billed charges3.030.75999999999Percent of total billed charges3.510.87999999999Percent of total billed charges2.910.721999999999Percent of total billed charges2.913.68
METOLAZONE TAB [2.5 MG]2500094CDM250RCboth4.152.913.530.85999999999 Percent of total billed charges3.780.91999999999 Percent of total billed charges3.240.78999999999Percent of total billed charges3.110.75999999999Percent of total billed charges3.610.87999999999Percent of total billed charges2.990.721999999999Percent of total billed charges2.993.78
CEFAZOLIN **IVPB** 1000 MG/NS 50 ML2500396CDM250RCboth4.182.933.550.85999999999 Percent of total billed charges3.80.91999999999 Percent of total billed charges3.260.78999999999Percent of total billed charges3.140.75999999999Percent of total billed charges3.640.87999999999Percent of total billed charges3.010.721999999999Percent of total billed charges3.013.8
CEFAZOLIN INJ [1 GM]2500233CDM250RCboth4.182.933.550.85999999999 Percent of total billed charges3.80.91999999999 Percent of total billed charges3.260.78999999999Percent of total billed charges3.140.75999999999Percent of total billed charges3.640.87999999999Percent of total billed charges3.010.721999999999Percent of total billed charges3.013.8
DEEP SEA NASAL SPRAY2500207CDM250RCboth4.22.943.570.85999999999 Percent of total billed charges3.820.91999999999 Percent of total billed charges3.280.78999999999Percent of total billed charges3.150.75999999999Percent of total billed charges3.650.87999999999Percent of total billed charges3.030.721999999999Percent of total billed charges3.033.82
CARVEDILOL TAB 6.25 MG2500024CDM250RCboth4.272.993.630.85999999999 Percent of total billed charges3.890.91999999999 Percent of total billed charges3.330.78999999999Percent of total billed charges3.20.75999999999Percent of total billed charges3.710.87999999999Percent of total billed charges3.080.721999999999Percent of total billed charges3.083.89
CARVEDILOL TAB. 25MG2500025CDM250RCboth4.272.993.630.85999999999 Percent of total billed charges3.890.91999999999 Percent of total billed charges3.330.78999999999Percent of total billed charges3.20.75999999999Percent of total billed charges3.710.87999999999Percent of total billed charges3.080.721999999999Percent of total billed charges3.083.89
NICOTINE TRANSDERMAL PATCH [21 MG/24 HR]2500198CDM250RCboth4.2833.640.85999999999 Percent of total billed charges3.890.91999999999 Percent of total billed charges3.340.78999999999Percent of total billed charges3.210.75999999999Percent of total billed charges3.720.87999999999Percent of total billed charges3.090.721999999999Percent of total billed charges3.093.89
KETOROLAC TAB [10 MG]2500071CDM250RCboth4.313.023.660.85999999999 Percent of total billed charges3.920.91999999999 Percent of total billed charges3.360.78999999999Percent of total billed charges3.230.75999999999Percent of total billed charges3.750.87999999999Percent of total billed charges3.110.721999999999Percent of total billed charges3.113.92
Budesonide Inhalation 0.25 mg/2ml122021CDM250RCboth4.53.153.830.85999999999 Percent of total billed charges4.10.91999999999 Percent of total billed charges3.510.78999999999Percent of total billed charges3.380.75999999999Percent of total billed charges3.920.87999999999Percent of total billed charges3.240.721999999999Percent of total billed charges3.244.1
LOSARTAN TAB [50 MG]2500084CDM250RCboth4.533.173.850.85999999999 Percent of total billed charges4.120.91999999999 Percent of total billed charges3.530.78999999999Percent of total billed charges3.40.75999999999Percent of total billed charges3.940.87999999999Percent of total billed charges3.270.721999999999Percent of total billed charges3.274.12
IPRATROPIUM BROMIDE/ALBUTEROL [0.5 MG/32500443CDM250RCboth4.593.213.90.85999999999 Percent of total billed charges4.180.91999999999 Percent of total billed charges3.580.78999999999Percent of total billed charges3.440.75999999999Percent of total billed charges3.990.87999999999Percent of total billed charges3.310.721999999999Percent of total billed charges3.314.18
METRONIDAZOLE/ NACL [500 MG/100 ML]2500315CDM250RCboth4.613.233.920.85999999999 Percent of total billed charges4.20.91999999999 Percent of total billed charges3.60.78999999999Percent of total billed charges3.460.75999999999Percent of total billed charges4.010.87999999999Percent of total billed charges3.320.721999999999Percent of total billed charges3.324.2
fentaNYL INJ [50MCG/1 ML]2500570CDM250RCboth4.683.283.980.85999999999 Percent of total billed charges4.260.91999999999 Percent of total billed charges3.650.78999999999Percent of total billed charges3.510.75999999999Percent of total billed charges4.070.87999999999Percent of total billed charges3.370.721999999999Percent of total billed charges3.374.26
MILK OF MAGNESIA [2400 MG/30 ML]2500465CDM250RCboth4.683.283.980.85999999999 Percent of total billed charges4.260.91999999999 Percent of total billed charges3.650.78999999999Percent of total billed charges3.510.75999999999Percent of total billed charges4.070.87999999999Percent of total billed charges3.370.721999999999Percent of total billed charges3.374.26
MAGNESIUM SULF INJ [1 GM/2 ML]2500276CDM250RCboth4.783.354.060.85999999999 Percent of total billed charges4.350.91999999999 Percent of total billed charges3.730.78999999999Percent of total billed charges3.590.75999999999Percent of total billed charges4.160.87999999999Percent of total billed charges3.450.721999999999Percent of total billed charges3.454.35
PHENYTOIN INJ [250 MG/5 ML]2500291CDM250RCboth4.783.354.060.85999999999 Percent of total billed charges4.350.91999999999 Percent of total billed charges3.730.78999999999Percent of total billed charges3.590.75999999999Percent of total billed charges4.160.87999999999Percent of total billed charges3.450.721999999999Percent of total billed charges3.454.35
PREDNISOLONE LIQ [15 MG/5 ML]2500225CDM250RCboth4.823.374.10.85999999999 Percent of total billed charges4.390.91999999999 Percent of total billed charges3.760.78999999999Percent of total billed charges3.620.75999999999Percent of total billed charges4.190.87999999999Percent of total billed charges3.480.721999999999Percent of total billed charges3.484.39
FAMOTIDINE TAB [20 MG]2500122CDM250RCboth4.843.394.110.85999999999 Percent of total billed charges4.40.91999999999 Percent of total billed charges3.780.78999999999Percent of total billed charges3.630.75999999999Percent of total billed charges4.210.87999999999Percent of total billed charges3.490.721999999999Percent of total billed charges3.494.4
Citalopram Oral Tablet 10 Mg2500027CDM250RCboth4.853.44.120.85999999999 Percent of total billed charges4.410.91999999999 Percent of total billed charges3.780.78999999999Percent of total billed charges3.640.75999999999Percent of total billed charges4.220.87999999999Percent of total billed charges3.50.721999999999Percent of total billed charges3.54.41
HEPARIN INJ [5,000 UNITS/ML]2500260CDM250RCboth4.853.44.120.85999999999 Percent of total billed charges4.410.91999999999 Percent of total billed charges3.780.78999999999Percent of total billed charges3.640.75999999999Percent of total billed charges4.220.87999999999Percent of total billed charges3.50.721999999999Percent of total billed charges3.54.41
FLUOXETINE CAP [20 MG]2500048CDM250RCboth4.973.484.220.85999999999 Percent of total billed charges4.520.91999999999 Percent of total billed charges3.880.78999999999Percent of total billed charges3.730.75999999999Percent of total billed charges4.320.87999999999Percent of total billed charges3.580.721999999999Percent of total billed charges3.584.52
ALLOPURINOL 100MG TAB120890CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
ALPRAZOLAM 0.5MG TAB120855CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
AMIDATE 2mg121528CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
AMIODARONE 200MG TAB12634CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
AMLODIPINE 5MG TAB121252CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
AMOXICILLIN 500MG CAP121166CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
ASPIRIN CHILDREN'S CHEWABLE 81MG TAB120078CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
ATENOLOL TABLETS 25MG121867CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
BACTRIM DS 800/160MG TAB120094CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
BENZONATATE 100MG CAP120739CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
BISACODYL 5MG TAB120232CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
BUPROPION ER 100MG TAB121504CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
BUSPIRONE 15MG TABLET120122CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CALCIUM + VIT.D 600MG/400UN TAB121808CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CALCIUM CARBON 500MG TAB120925CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CAPSULE GABAPENTIN 100MG121618CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CAPSULE LOVAZA 1000MG121609CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CARAFATE TAB 1 GRAM120146CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
Carbamide Peroxide Otic Drops121969CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CARBIDOPA/LEVODOPA 25/100 TAB.120674CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CARVEDILOL 25MG TAB121706CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CARVEDILOL 6.25MG TABLET121357CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CELEBREX 100 MG121348CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CETIRIZINE 10MG TAB12509CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CHLORDIAZEPOXIDE 10MG CAP120470CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CIPROFLOXACIN 500MG TAB121114CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CLINDAMYCIN 150MG. CAP120167CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CLONAZEPAM 0.5 MG TABLET121903CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CLONIDINE 0.1MG TAB120142CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
COLACE 100MG CAP120172CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
CYCLOBENZAPRINE 10MG TAB121843CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DEPAKOTE DR 500MG CAP121182CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DIAZEPAM 5 MG TAB120818CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DIGOXIN 0.125 MG. TAB120458CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DILTIAZEM CD 180 CAP121173CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DILTIAZEM HCI ER 120MG CAP120138CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DIPHENHYDRAMINE 25MG. CAP.120100CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DONEPEZIL 10MG TAB121898CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
DONNATAL ELIXIR ORAL SOL 5ML120226CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
FAMOTIDINE 20MG TAB121140CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
FENOFIBRATE 160MG TAB121723CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
FEOSOL SULFATE TAB. 325MG120354CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
FLUOXETINE HCL 20MG. TAB120634CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
FOLIC ACID TAB (1MG)120363CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
FUROSEMIDE 20 MG. TAB120463CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
FUROSEMIDE 40 MG. TAB120464CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
GABAPENTIN 300MG CAP120950CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
GLIMEPIRIDE 2MG TAB121379CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
GLIPIZIDE ER 2.5MG121953CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
GLUCOTROL 5MG. TAB.120379CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
GUAIFENESIN 600MG TAB121299CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
HYDRALAZINE 10 MG TAB121861CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
HYDROCHLOROTHIAZIDE 25MG TAB121429CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
HYDROCODONE APAP 10/325121671CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
HYDROCODONE APAP 5/325121817CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
HYDROCODONE/APAR 7.5/325 MG121838CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
HYDROXYCHLOROQUINE 200MG121949CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
HYDROXYZINE 25MG. CAP120844CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
IBUPROFEN 400MG. TAB120514CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
KCL 20MEQ TABLET120998CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
KEPPRA 500MG TABLET121536CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LEVOTHYROXINE 100MCG TAB120715CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LEVOTHYROXINE 50MCG TAB121747CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LEVOTHYROXINE 88MCG TAB121748CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LEXAPRO 10MG TAB121437CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LIPITOR 10MG TAB121285CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LISINOPRIL 10MG TAB121750CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LISINOPRIL 5MG TABLET120954CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LOPERAMIDE 2MG CAP120417CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LORAZEPAM 0.5MG TABLET120080CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LOSARTAN 50MG TAB121752CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LYRICA 100MG CAP121755CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LYRICA 50MG CAP121753CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
LYRICA 75MG CAP121754CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
MAG OXIDE 400MG TAB121235CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
MECLIZINE 12.5MG TAB121757CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
MELOXICAM (MOBIC) 7.5MG TAB121453CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
METFORMIN 500MG TAB120915CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
METHOCARBAMOL 500MG. TAB.120650CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
METOPROLOL 25MG TAB121762CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
METOPROLOL 50MG. TAB120480CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
METOPROLOL ER 25MG TAB121902CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
METOPROLOL ER 50 MG TAB121312CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
METRONIDAZOLE 500MG TAB121126CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
NAPROXEN 500MG TAB121244CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
NITROFURANTOIN 100MG CAPSULE121915CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
OXYBUTYNIN 5MG. TAB.120221CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
OXYCODONE/APAP 5/325121475CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
OXYCONTIN 10MG TAB121644CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PHENAZOPYRIDINE HCL 100MG TAB121775CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PHENYTOIN 100MG. CAP.120211CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
POTASSIUM CHLORIDE 40MEQ/15ML121776CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
Potassium Chloride Powder 20meq122000CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PRAMIPEXOLE 0.25 MG TAB121926CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PREDNISONE 20MG. TAB120195CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PREDNISONE 5MG. TAB.120194CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PROBIOTIC121019CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PROMETHAZINE 25MG TAB121141CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PROMETHAZINE INJ [25 MG/ML]2500289CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PROPRANOLOL 20MG TAB120419CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
RANITIDINE 150 MG. TAB.120873CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
ROPINIROLE 0.5MG TAB121782CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
ROPINIROLE TAB [0.5 MG]2500125CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
SENNA-LAX 8.6MG TAB120666CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
SERTRALINE 100MG TABLETS121574CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
SERTRALINE 25MG TAB121785CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
SPIRONOLACTONE 25MG TAB120024CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TEMAZEPAM 15MG. CAP120957CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TERAZOSIN 1MG CAP121789CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
THERAGRAN-M TAB.120748CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TIROSINT 112 MCQ CAPS121831CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TIROSINT 75MCG121840CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TIZANIDINE 4MG TAB121551CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TORSEMIDE 20MG TAB120054CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TRAMADOL 50MG TAB120710CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TRAZADONE 50MG. TAB120204CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TYLENOL #3 300/30MG TABLET120002CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TYLENOL 325MG TABLET120008CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
TYLENOL 500MG TABLET120010CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
VALPROIC ACID 250MG/5ML121793CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
VENLAFAXINE ER 37.5MG TAB121795CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
Verapamil ER 240MG TABLET120125CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
VITAMIN B12 1000MCG TABLETS121859CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
VITAMIN D 1000 IU CAP121799CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PHENYLEPHRINE**IV DRIP** 10MG/NS 250ML2500578CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
PHENYLEPHRINE INJ.[10MG/ML]2500579CDM250RCboth53.54.250.85999999999 Percent of total billed charges4.550.91999999999 Percent of total billed charges3.90.78999999999Percent of total billed charges3.750.75999999999Percent of total billed charges4.350.87999999999Percent of total billed charges3.610.721999999999Percent of total billed charges3.614.55
NICOTINE TRANSDERM PATCH [14 MG]2500196CDM250RCboth5.043.534.280.85999999999 Percent of total billed charges4.590.91999999999 Percent of total billed charges3.930.78999999999Percent of total billed charges3.780.75999999999Percent of total billed charges4.380.87999999999Percent of total billed charges3.630.721999999999Percent of total billed charges3.634.59
FENTANYL INJ [100 MCG/2 ML]2500325CDM250RCboth5.083.564.320.85999999999 Percent of total billed charges4.620.91999999999 Percent of total billed charges3.960.78999999999Percent of total billed charges3.810.75999999999Percent of total billed charges4.420.87999999999Percent of total billed charges3.660.721999999999Percent of total billed charges3.664.62
DIGOXIN TAB [0.125 MG]2500034CDM250RCboth5.123.584.350.85999999999 Percent of total billed charges4.660.91999999999 Percent of total billed charges3.990.78999999999Percent of total billed charges3.840.75999999999Percent of total billed charges4.450.87999999999Percent of total billed charges3.690.721999999999Percent of total billed charges3.694.66
WARFARIN TAB [2 MG]2500145CDM250RCboth5.163.614.390.85999999999 Percent of total billed charges4.70.91999999999 Percent of total billed charges4.020.78999999999Percent of total billed charges3.870.75999999999Percent of total billed charges4.490.87999999999Percent of total billed charges3.720.721999999999Percent of total billed charges3.724.7
PHENAZOPYRIDINE TAB [100 MG]2500108CDM250RCboth5.43.784.590.85999999999 Percent of total billed charges4.910.91999999999 Percent of total billed charges4.210.78999999999Percent of total billed charges4.050.75999999999Percent of total billed charges4.70.87999999999Percent of total billed charges3.890.721999999999Percent of total billed charges3.894.91
NITROGLYCERIN 2% OINT [1 GM]2500522CDM250RCboth5.513.864.680.85999999999 Percent of total billed charges5.010.91999999999 Percent of total billed charges4.30.78999999999Percent of total billed charges4.130.75999999999Percent of total billed charges4.790.87999999999Percent of total billed charges3.970.721999999999Percent of total billed charges3.975.01
PAROXETINE TAB [20 MG]2500106CDM250RCboth5.583.914.740.85999999999 Percent of total billed charges5.080.91999999999 Percent of total billed charges4.350.78999999999Percent of total billed charges4.190.75999999999Percent of total billed charges4.850.87999999999Percent of total billed charges4.020.721999999999Percent of total billed charges4.025.08
IV - NACL 0.9% [50 ML]2500357CDM250RCboth5.613.934.770.85999999999 Percent of total billed charges5.110.91999999999 Percent of total billed charges4.380.78999999999Percent of total billed charges4.210.75999999999Percent of total billed charges4.880.87999999999Percent of total billed charges4.040.721999999999Percent of total billed charges4.045.11
CETIRIZINE ORAL SOL [5 MG/5 ML]2500466CDM250RCboth5.744.024.880.85999999999 Percent of total billed charges5.220.91999999999 Percent of total billed charges4.480.78999999999Percent of total billed charges4.310.75999999999Percent of total billed charges4.990.87999999999Percent of total billed charges4.140.721999999999Percent of total billed charges4.145.22
CEFTRIAXONE **IVPB** 1 GM/NS 50 ML2500387CDM250RCboth5.764.034.90.85999999999 Percent of total billed charges5.240.91999999999 Percent of total billed charges4.490.78999999999Percent of total billed charges4.320.75999999999Percent of total billed charges5.010.87999999999Percent of total billed charges4.150.721999999999Percent of total billed charges4.155.24
cefTRIAXone INJ [1 GM]2500237CDM250RCboth5.764.034.90.85999999999 Percent of total billed charges5.240.91999999999 Percent of total billed charges4.490.78999999999Percent of total billed charges4.320.75999999999Percent of total billed charges5.010.87999999999Percent of total billed charges4.150.721999999999Percent of total billed charges4.155.24
HYDROCODONE POLISTIREX/CHlorph2500329CDM250RCboth5.874.114.990.85999999999 Percent of total billed charges5.340.91999999999 Percent of total billed charges4.580.78999999999Percent of total billed charges4.40.75999999999Percent of total billed charges5.110.87999999999Percent of total billed charges4.230.721999999999Percent of total billed charges4.235.34
PRAMIPEXOLE TAB [0.25 MG]2500113CDM250RCboth5.884.1250.85999999999 Percent of total billed charges5.350.91999999999 Percent of total billed charges4.590.78999999999Percent of total billed charges4.410.75999999999Percent of total billed charges5.120.87999999999Percent of total billed charges4.240.721999999999Percent of total billed charges4.245.35
HYDROCORTISONE 1% CREAM2500204CDM250RCboth5.94.135.020.85999999999 Percent of total billed charges5.370.91999999999 Percent of total billed charges4.60.78999999999Percent of total billed charges4.430.75999999999Percent of total billed charges5.130.87999999999Percent of total billed charges4.250.721999999999Percent of total billed charges4.255.37
KEFLEX 250MG. CAP120448CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
KEPPRA 500 MG IVPB2500514CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
MIRTAZAPINE 15MG TAB121478CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
ONDANSETRON ODT 8MG121863CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
RANEXA 500MG TAB121826CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
RISPERDAL 1MG TAB121287CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
ZOVIRAX 400MG TAB121272CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
MORPHINE SULFATE INJ [4 MG/ML]2500339CDM250RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
IV - NACL 0.9% [100 ML]2500358CDM250RCboth6.034.225.130.85999999999 Percent of total billed charges5.490.91999999999 Percent of total billed charges4.70.78999999999Percent of total billed charges4.520.75999999999Percent of total billed charges5.250.87999999999Percent of total billed charges4.350.721999999999Percent of total billed charges4.355.49
MEPERIDINE INJ [25 MG/ML]2500318CDM250RCboth6.14.275.190.85999999999 Percent of total billed charges5.550.91999999999 Percent of total billed charges4.760.78999999999Percent of total billed charges4.580.75999999999Percent of total billed charges5.310.87999999999Percent of total billed charges4.40.721999999999Percent of total billed charges4.45.55
MORPHINE SULFATE INJ [10 MG/ML]2500341CDM250RCboth6.124.285.20.85999999999 Percent of total billed charges5.570.91999999999 Percent of total billed charges4.770.78999999999Percent of total billed charges4.590.75999999999Percent of total billed charges5.320.87999999999Percent of total billed charges4.410.721999999999Percent of total billed charges4.415.57
MELOXICAM TAB [7.5 MG]2500087CDM250RCboth6.24.345.270.85999999999 Percent of total billed charges5.640.91999999999 Percent of total billed charges4.840.78999999999Percent of total billed charges4.650.75999999999Percent of total billed charges5.390.87999999999Percent of total billed charges4.470.721999999999Percent of total billed charges4.475.64
MEPERIDINE HCL INJ [50 MG/ ML]2500319CDM250RCboth6.344.445.390.85999999999 Percent of total billed charges5.770.91999999999 Percent of total billed charges4.950.78999999999Percent of total billed charges4.760.75999999999Percent of total billed charges5.520.87999999999Percent of total billed charges4.570.721999999999Percent of total billed charges4.575.77
PRAVASTATIN TAB [10 MG]2500119CDM250RCboth6.44.485.440.85999999999 Percent of total billed charges5.820.91999999999 Percent of total billed charges4.990.78999999999Percent of total billed charges4.80.75999999999Percent of total billed charges5.570.87999999999Percent of total billed charges4.610.721999999999Percent of total billed charges4.615.82
INSTA-GLUCOSE2500218CDM250RCboth6.424.495.460.85999999999 Percent of total billed charges5.840.91999999999 Percent of total billed charges5.010.78999999999Percent of total billed charges4.820.75999999999Percent of total billed charges5.590.87999999999Percent of total billed charges4.630.721999999999Percent of total billed charges4.635.84
HEPARIN INJ [1,000 UNITS/ML]2500259CDM250RCboth6.624.635.630.85999999999 Percent of total billed charges6.020.91999999999 Percent of total billed charges5.160.78999999999Percent of total billed charges4.970.75999999999Percent of total billed charges5.760.87999999999Percent of total billed charges4.770.721999999999Percent of total billed charges4.776.02
CIPROFLOXACIN I.V.-IN D5W2500316CDM250RCboth6.74.695.70.85999999999 Percent of total billed charges6.10.91999999999 Percent of total billed charges5.230.78999999999Percent of total billed charges5.030.75999999999Percent of total billed charges5.830.87999999999Percent of total billed charges4.830.721999999999Percent of total billed charges4.836.1
NITROFURANTOIN CAP [100 MG]2500169CDM250RCboth6.754.735.740.85999999999 Percent of total billed charges6.140.91999999999 Percent of total billed charges5.270.78999999999Percent of total billed charges5.060.75999999999Percent of total billed charges5.870.87999999999Percent of total billed charges4.870.721999999999Percent of total billed charges4.876.14
MORPHINE SULFATE INJ [8 MG/ML]2500340CDM250RCboth6.764.735.750.85999999999 Percent of total billed charges6.150.91999999999 Percent of total billed charges5.270.78999999999Percent of total billed charges5.070.75999999999Percent of total billed charges5.880.87999999999Percent of total billed charges4.870.721999999999Percent of total billed charges4.876.15
MORPHINE SULFATE INJ [2 MG/ML]2500338CDM250RCboth6.894.825.860.85999999999 Percent of total billed charges6.270.91999999999 Percent of total billed charges5.370.78999999999Percent of total billed charges5.170.75999999999Percent of total billed charges5.990.87999999999Percent of total billed charges4.970.721999999999Percent of total billed charges4.976.27
DEXAMETHASONE INJ [4 MG/ML]2500244CDM250RCboth6.924.845.880.85999999999 Percent of total billed charges6.30.91999999999 Percent of total billed charges5.40.78999999999Percent of total billed charges5.190.75999999999Percent of total billed charges6.020.87999999999Percent of total billed charges4.990.721999999999Percent of total billed charges4.996.3
MEPERIDINE INJ [100 MG/ML]2500320CDM250RCboth6.964.875.920.85999999999 Percent of total billed charges6.330.91999999999 Percent of total billed charges5.430.78999999999Percent of total billed charges5.220.75999999999Percent of total billed charges6.060.87999999999Percent of total billed charges5.020.721999999999Percent of total billed charges5.026.33
GNP ZINC OXIDE2500205CDM250RCboth6.984.895.930.85999999999 Percent of total billed charges6.350.91999999999 Percent of total billed charges5.440.78999999999Percent of total billed charges5.240.75999999999Percent of total billed charges6.070.87999999999Percent of total billed charges5.030.721999999999Percent of total billed charges5.036.35
LEVOFLOXACIN/ D5W [500 MG/100 ML]2500310CDM250RCboth74.95.950.85999999999 Percent of total billed charges6.370.91999999999 Percent of total billed charges5.460.78999999999Percent of total billed charges5.250.75999999999Percent of total billed charges6.090.87999999999Percent of total billed charges5.050.721999999999Percent of total billed charges5.056.37
PANTOPRAZOLE 40MG P.O. TABLET121471CDM250RCboth74.95.950.85999999999 Percent of total billed charges6.370.91999999999 Percent of total billed charges5.460.78999999999Percent of total billed charges5.250.75999999999Percent of total billed charges6.090.87999999999Percent of total billed charges5.050.721999999999Percent of total billed charges5.056.37
Juven nutrition2500590CDM250RCboth74.95.950.85999999999 Percent of total billed charges6.370.91999999999 Percent of total billed charges5.460.78999999999Percent of total billed charges5.250.75999999999Percent of total billed charges6.090.87999999999Percent of total billed charges5.050.721999999999Percent of total billed charges5.056.37
LEVETIRACETAM TAB [500 MG]2500072CDM250RCboth7.034.925.980.85999999999 Percent of total billed charges6.40.91999999999 Percent of total billed charges5.480.78999999999Percent of total billed charges5.270.75999999999Percent of total billed charges6.120.87999999999Percent of total billed charges5.070.721999999999Percent of total billed charges5.076.4
CLINDAMYCIN **IVPB** 600 MG/NS 50 ML2500401CDM250RCboth7.064.9460.85999999999 Percent of total billed charges6.420.91999999999 Percent of total billed charges5.510.78999999999Percent of total billed charges5.30.75999999999Percent of total billed charges6.140.87999999999Percent of total billed charges5.090.721999999999Percent of total billed charges5.096.42
BUPIVACAINE HCL 0.5% [50 MG/ 10 ML]2500231CDM250RCboth7.25.046.120.85999999999 Percent of total billed charges6.550.91999999999 Percent of total billed charges5.620.78999999999Percent of total billed charges5.40.75999999999Percent of total billed charges6.260.87999999999Percent of total billed charges5.190.721999999999Percent of total billed charges5.196.55
VANCOMYCIN INJ [500 MG]2500304CDM250RCboth7.25.046.120.85999999999 Percent of total billed charges6.550.91999999999 Percent of total billed charges5.620.78999999999Percent of total billed charges5.40.75999999999Percent of total billed charges6.260.87999999999Percent of total billed charges5.190.721999999999Percent of total billed charges5.196.55
DIPHENHYDRAMINE INJ [50 MG/ML]2500247CDM250RCboth7.225.056.140.85999999999 Percent of total billed charges6.570.91999999999 Percent of total billed charges5.630.78999999999Percent of total billed charges5.420.75999999999Percent of total billed charges6.280.87999999999Percent of total billed charges5.210.721999999999Percent of total billed charges5.216.57
QUETIAPINE TAB [25 MG]2500120CDM250RCboth7.435.26.320.85999999999 Percent of total billed charges6.760.91999999999 Percent of total billed charges5.80.78999999999Percent of total billed charges5.570.75999999999Percent of total billed charges6.460.87999999999Percent of total billed charges5.360.721999999999Percent of total billed charges5.366.76
VENLAFAXINE ER CAP [37.5 MG]2500140CDM250RCboth7.485.246.360.85999999999 Percent of total billed charges6.810.91999999999 Percent of total billed charges5.830.78999999999Percent of total billed charges5.610.75999999999Percent of total billed charges6.510.87999999999Percent of total billed charges5.390.721999999999Percent of total billed charges5.396.81
VANCOMYCIN **IVPB** 500 MG/NS 100 ML2500400CDM250RCboth7.55.256.380.85999999999 Percent of total billed charges6.830.91999999999 Percent of total billed charges5.850.78999999999Percent of total billed charges5.630.75999999999Percent of total billed charges6.530.87999999999Percent of total billed charges5.410.721999999999Percent of total billed charges5.416.83
CEFEPIME **IVPB** 1000 MG/NS 50 ML2500395CDM250RCboth7.545.286.410.85999999999 Percent of total billed charges6.860.91999999999 Percent of total billed charges5.880.78999999999Percent of total billed charges5.660.75999999999Percent of total billed charges6.560.87999999999Percent of total billed charges5.440.721999999999Percent of total billed charges5.446.86
CEFEPIME INJ [1 GM]2500232CDM250RCboth7.545.286.410.85999999999 Percent of total billed charges6.860.91999999999 Percent of total billed charges5.880.78999999999Percent of total billed charges5.660.75999999999Percent of total billed charges6.560.87999999999Percent of total billed charges5.440.721999999999Percent of total billed charges5.446.86
AMOXICIL/ POT CLAV TAB [500 MG]2500158CDM250RCboth7.575.36.430.85999999999 Percent of total billed charges6.890.91999999999 Percent of total billed charges5.90.78999999999Percent of total billed charges5.680.75999999999Percent of total billed charges6.590.87999999999Percent of total billed charges5.460.721999999999Percent of total billed charges5.466.89
MAG-AL PLUS2500221CDM250RCboth7.595.316.450.85999999999 Percent of total billed charges6.910.91999999999 Percent of total billed charges5.920.78999999999Percent of total billed charges5.690.75999999999Percent of total billed charges6.60.87999999999Percent of total billed charges5.470.721999999999Percent of total billed charges5.476.91
NEO-SYNEPHRINE COLD & SIN2500186CDM250RCboth7.65.326.460.85999999999 Percent of total billed charges6.920.91999999999 Percent of total billed charges5.930.78999999999Percent of total billed charges5.70.75999999999Percent of total billed charges6.610.87999999999Percent of total billed charges5.480.721999999999Percent of total billed charges5.486.92
Rocuronium Bromide Intravenous Solution2500523CDM250RCboth7.865.56.680.85999999999 Percent of total billed charges7.150.91999999999 Percent of total billed charges6.130.78999999999Percent of total billed charges5.90.75999999999Percent of total billed charges6.840.87999999999Percent of total billed charges5.670.721999999999Percent of total billed charges5.677.15
CEFAZOLIN**IVPB**2GM/100ML2500580CDM250RCboth7.925.546.730.85999999999 Percent of total billed charges7.210.91999999999 Percent of total billed charges6.180.78999999999Percent of total billed charges5.940.75999999999Percent of total billed charges6.890.87999999999Percent of total billed charges5.710.721999999999Percent of total billed charges5.717.21
AZITHROMYCIN 250MG TABLET121158CDM250RCboth85.66.80.85999999999 Percent of total billed charges7.280.91999999999 Percent of total billed charges6.240.78999999999Percent of total billed charges60.75999999999Percent of total billed charges6.960.87999999999Percent of total billed charges5.770.721999999999Percent of total billed charges5.777.28
DETROL LA 2MG CAP121717CDM250RCboth85.66.80.85999999999 Percent of total billed charges7.280.91999999999 Percent of total billed charges6.240.78999999999Percent of total billed charges60.75999999999Percent of total billed charges6.960.87999999999Percent of total billed charges5.770.721999999999Percent of total billed charges5.777.28
LORATADINE 10MG TAB121180CDM250RCboth85.66.80.85999999999 Percent of total billed charges7.280.91999999999 Percent of total billed charges6.240.78999999999Percent of total billed charges60.75999999999Percent of total billed charges6.960.87999999999Percent of total billed charges5.770.721999999999Percent of total billed charges5.777.28
METHOTREXATE 2.5MG TAB121133CDM250RCboth85.66.80.85999999999 Percent of total billed charges7.280.91999999999 Percent of total billed charges6.240.78999999999Percent of total billed charges60.75999999999Percent of total billed charges6.960.87999999999Percent of total billed charges5.770.721999999999Percent of total billed charges5.777.28
OMNICEF 300MG121463CDM250RCboth85.66.80.85999999999 Percent of total billed charges7.280.91999999999 Percent of total billed charges6.240.78999999999Percent of total billed charges60.75999999999Percent of total billed charges6.960.87999999999Percent of total billed charges5.770.721999999999Percent of total billed charges5.777.28
TAMIFLU ORAL SUSP 6MG/ML121537CDM250RCboth85.66.80.85999999999 Percent of total billed charges7.280.91999999999 Percent of total billed charges6.240.78999999999Percent of total billed charges60.75999999999Percent of total billed charges6.960.87999999999Percent of total billed charges5.770.721999999999Percent of total billed charges5.777.28
XYLOCAINE 2% WITH EPI INJEC.121008CDM250RCboth85.66.80.85999999999 Percent of total billed charges7.280.91999999999 Percent of total billed charges6.240.78999999999Percent of total billed charges60.75999999999Percent of total billed charges6.960.87999999999Percent of total billed charges5.770.721999999999Percent of total billed charges5.777.28
CIPROFLOXACIN/D5W2500314CDM250RCboth8.45.887.140.85999999999 Percent of total billed charges7.640.91999999999 Percent of total billed charges6.550.78999999999Percent of total billed charges6.30.75999999999Percent of total billed charges7.310.87999999999Percent of total billed charges6.060.721999999999Percent of total billed charges6.067.64
AZITHROMYCIN **IVPB** 500 MG/250 ML2500389CDM250RCboth8.45.887.140.85999999999 Percent of total billed charges7.640.91999999999 Percent of total billed charges6.550.78999999999Percent of total billed charges6.30.75999999999Percent of total billed charges7.310.87999999999Percent of total billed charges6.060.721999999999Percent of total billed charges6.067.64
TAMSULOSIN CAP [0.4 MG]2500132CDM250RCboth8.435.97.170.85999999999 Percent of total billed charges7.670.91999999999 Percent of total billed charges6.580.78999999999Percent of total billed charges6.320.75999999999Percent of total billed charges7.330.87999999999Percent of total billed charges6.080.721999999999Percent of total billed charges6.087.67
OXYTOCIN INJ [10 UNITS/ML]2500285CDM250RCboth8.646.057.340.85999999999 Percent of total billed charges7.860.91999999999 Percent of total billed charges6.740.78999999999Percent of total billed charges6.480.75999999999Percent of total billed charges7.520.87999999999Percent of total billed charges6.230.721999999999Percent of total billed charges6.237.86
POTASSIUM CHLORIDE [20 MEQ/10 ML]2500287CDM250RCboth8.726.17.410.85999999999 Percent of total billed charges7.940.91999999999 Percent of total billed charges6.80.78999999999Percent of total billed charges6.540.75999999999Percent of total billed charges7.590.87999999999Percent of total billed charges6.290.721999999999Percent of total billed charges6.297.94
ESCITALOPRAM TAB [10 MG]2500376CDM250RCboth8.766.137.450.85999999999 Percent of total billed charges7.970.91999999999 Percent of total billed charges6.830.78999999999Percent of total billed charges6.570.75999999999Percent of total billed charges7.620.87999999999Percent of total billed charges6.320.721999999999Percent of total billed charges6.327.97
HYDROXYCHLOROQUINE TAB [200 MG]2500063CDM250RCboth8.786.157.460.85999999999 Percent of total billed charges7.990.91999999999 Percent of total billed charges6.850.78999999999Percent of total billed charges6.590.75999999999Percent of total billed charges7.640.87999999999Percent of total billed charges6.330.721999999999Percent of total billed charges6.337.99
TOPIRAMATE TAB [50 MG]2500136CDM250RCboth8.856.27.520.85999999999 Percent of total billed charges8.050.91999999999 Percent of total billed charges6.90.78999999999Percent of total billed charges6.640.75999999999Percent of total billed charges7.70.87999999999Percent of total billed charges6.380.721999999999Percent of total billed charges6.388.05
PROMETHAZINE HCL [50 MG/ML]2500290CDM250RCboth96.37.650.85999999999 Percent of total billed charges8.190.91999999999 Percent of total billed charges7.020.78999999999Percent of total billed charges6.750.75999999999Percent of total billed charges7.830.87999999999Percent of total billed charges6.490.721999999999Percent of total billed charges6.498.19
MEGESTROL SUSP 400MG/10ML2500451CDM250RCboth9.056.347.690.85999999999 Percent of total billed charges8.240.91999999999 Percent of total billed charges7.060.78999999999Percent of total billed charges6.790.75999999999Percent of total billed charges7.870.87999999999Percent of total billed charges6.530.721999999999Percent of total billed charges6.538.24
RISPERIDONE TAB [1 MG]2500123CDM250RCboth9.136.397.760.85999999999 Percent of total billed charges8.310.91999999999 Percent of total billed charges7.120.78999999999Percent of total billed charges6.850.75999999999Percent of total billed charges7.940.87999999999Percent of total billed charges6.580.721999999999Percent of total billed charges6.588.31
CELECOXIB CAP [100 MG]2500374CDM250RCboth9.236.467.850.85999999999 Percent of total billed charges8.40.91999999999 Percent of total billed charges7.20.78999999999Percent of total billed charges6.920.75999999999Percent of total billed charges8.030.87999999999Percent of total billed charges6.650.721999999999Percent of total billed charges6.658.4
IV- NACL 0.9% 250 ML2500390CDM250RCboth9.446.618.020.85999999999 Percent of total billed charges8.590.91999999999 Percent of total billed charges7.360.78999999999Percent of total billed charges7.080.75999999999Percent of total billed charges8.210.87999999999Percent of total billed charges6.810.721999999999Percent of total billed charges6.818.59
IV - D5W [250 ML]2500365CDM250RCboth9.486.648.060.85999999999 Percent of total billed charges8.630.91999999999 Percent of total billed charges7.390.78999999999Percent of total billed charges7.110.75999999999Percent of total billed charges8.250.87999999999Percent of total billed charges6.840.721999999999Percent of total billed charges6.848.63
MG 2GM BOLUS2500516CDM250RCboth9.566.698.130.85999999999 Percent of total billed charges8.70.91999999999 Percent of total billed charges7.460.78999999999Percent of total billed charges7.170.75999999999Percent of total billed charges8.320.87999999999Percent of total billed charges6.890.721999999999Percent of total billed charges6.898.7
PHENYTOIN 500 MG IVPB2500551CDM250RCboth9.566.698.130.85999999999 Percent of total billed charges8.70.91999999999 Percent of total billed charges7.460.78999999999Percent of total billed charges7.170.75999999999Percent of total billed charges8.320.87999999999Percent of total billed charges6.890.721999999999Percent of total billed charges6.898.7
ARTIFICIAL TEARS SOL 15ML121855CDM250RCboth1078.50.85999999999 Percent of total billed charges9.10.91999999999 Percent of total billed charges7.80.78999999999Percent of total billed charges7.50.75999999999Percent of total billed charges8.70.87999999999Percent of total billed charges7.210.721999999999Percent of total billed charges7.219.1
CYMBALTA 30MG121409CDM250RCboth1078.50.85999999999 Percent of total billed charges9.10.91999999999 Percent of total billed charges7.80.78999999999Percent of total billed charges7.50.75999999999Percent of total billed charges8.70.87999999999Percent of total billed charges7.210.721999999999Percent of total billed charges7.219.1
PLAVIX 75MG TAB121325CDM250RCboth1078.50.85999999999 Percent of total billed charges9.10.91999999999 Percent of total billed charges7.80.78999999999Percent of total billed charges7.50.75999999999Percent of total billed charges8.70.87999999999Percent of total billed charges7.210.721999999999Percent of total billed charges7.219.1
TRANSDERM SCOP PATCH120789CDM250RCboth1078.50.85999999999 Percent of total billed charges9.10.91999999999 Percent of total billed charges7.80.78999999999Percent of total billed charges7.50.75999999999Percent of total billed charges8.70.87999999999Percent of total billed charges7.210.721999999999Percent of total billed charges7.219.1
IV - NACL 0.9% [500 ML]2500364CDM250RCboth10.127.088.60.85999999999 Percent of total billed charges9.210.91999999999 Percent of total billed charges7.890.78999999999Percent of total billed charges7.590.75999999999Percent of total billed charges8.80.87999999999Percent of total billed charges7.30.721999999999Percent of total billed charges7.39.21
AMOXICIL/ POT CLAV+B94 TAB [875 MG]2500159CDM250RCboth10.147.18.620.85999999999 Percent of total billed charges9.230.91999999999 Percent of total billed charges7.910.78999999999Percent of total billed charges7.610.75999999999Percent of total billed charges8.820.87999999999Percent of total billed charges7.310.721999999999Percent of total billed charges7.319.23
CEFDINIR CAP [300 MG]2500162CDM250RCboth10.237.168.70.85999999999 Percent of total billed charges9.310.91999999999 Percent of total billed charges7.980.78999999999Percent of total billed charges7.670.75999999999Percent of total billed charges8.90.87999999999Percent of total billed charges7.380.721999999999Percent of total billed charges7.389.31
Hydrocodone/AC Liq 7.5/325mg 15 mL2500453CDM250RCboth10.647.459.040.85999999999 Percent of total billed charges9.680.91999999999 Percent of total billed charges8.30.78999999999Percent of total billed charges7.980.75999999999Percent of total billed charges9.260.87999999999Percent of total billed charges7.670.721999999999Percent of total billed charges7.679.68
ETOMIDATE INJ [2MG/ML]2500252CDM250RCboth10.667.469.060.85999999999 Percent of total billed charges9.70.91999999999 Percent of total billed charges8.310.78999999999Percent of total billed charges80.75999999999Percent of total billed charges9.270.87999999999Percent of total billed charges7.690.721999999999Percent of total billed charges7.699.7
AROMATIC AMMONIA INHALANT2500197CDM250RCboth10.727.59.110.85999999999 Percent of total billed charges9.760.91999999999 Percent of total billed charges8.360.78999999999Percent of total billed charges8.040.75999999999Percent of total billed charges9.330.87999999999Percent of total billed charges7.730.721999999999Percent of total billed charges7.739.76
PROCHLORPERAZINE INJ [5 MG/ML]2500295CDM250RCboth10.87.569.180.85999999999 Percent of total billed charges9.830.91999999999 Percent of total billed charges8.420.78999999999Percent of total billed charges8.10.75999999999Percent of total billed charges9.40.87999999999Percent of total billed charges7.790.721999999999Percent of total billed charges7.799.83
LANTISEPTIC [50 %]2500534CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
AZITHROMYCIN ORAL SUSP. 100MG/5ML121505CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
CEFDINIR 125MG/5ML ORAL SUSP121900CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
HYDROCORTISONE 1% CR121190CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
MORPHINE 2MG INJ121455CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
NYSTATIN CREAM 30GR121512CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
ONDANSETRON HCL 4MG TABLET121560CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
RACENIC EPI NEB SOLU120956CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
Rocuronium 50mg per 5ml122003CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
VIBRAMYCIN 100MG. CAP120839CDM250RCboth117.79.350.85999999999 Percent of total billed charges10.010.91999999999 Percent of total billed charges8.580.78999999999Percent of total billed charges8.250.75999999999Percent of total billed charges9.570.87999999999Percent of total billed charges7.930.721999999999Percent of total billed charges7.9310.01
MONTELUKAST TAB [10 MG]2500097CDM250RCboth11.017.719.360.85999999999 Percent of total billed charges10.020.91999999999 Percent of total billed charges8.590.78999999999Percent of total billed charges8.260.75999999999Percent of total billed charges9.580.87999999999Percent of total billed charges7.940.721999999999Percent of total billed charges7.9410.02
LACTATED RINGERS [500 ML]2500368CDM250RCboth11.077.759.410.85999999999 Percent of total billed charges10.070.91999999999 Percent of total billed charges8.630.78999999999Percent of total billed charges8.30.75999999999Percent of total billed charges9.630.87999999999Percent of total billed charges7.980.721999999999Percent of total billed charges7.9810.07
IV - D5 1/2 NACL [500 ML]2500359CDM250RCboth11.317.929.610.85999999999 Percent of total billed charges10.290.91999999999 Percent of total billed charges8.820.78999999999Percent of total billed charges8.480.75999999999Percent of total billed charges9.840.87999999999Percent of total billed charges8.150.721999999999Percent of total billed charges8.1510.29
OXYMETAZOLINE 0.05% NASAL SPRAY2500189CDM250RCboth11.387.979.670.85999999999 Percent of total billed charges10.360.91999999999 Percent of total billed charges8.880.78999999999Percent of total billed charges8.540.75999999999Percent of total billed charges9.90.87999999999Percent of total billed charges8.20.721999999999Percent of total billed charges8.210.36
CEFRTIAXONE IVPB 2 GM2500518CDM250RCboth11.528.069.790.85999999999 Percent of total billed charges10.480.91999999999 Percent of total billed charges8.990.78999999999Percent of total billed charges8.640.75999999999Percent of total billed charges10.020.87999999999Percent of total billed charges8.310.721999999999Percent of total billed charges8.3110.48
FOLIC ACID INJ [5 MG/ML]2500251CDM250RCboth11.88.2610.030.85999999999 Percent of total billed charges10.740.91999999999 Percent of total billed charges9.20.78999999999Percent of total billed charges8.850.75999999999Percent of total billed charges10.270.87999999999Percent of total billed charges8.510.721999999999Percent of total billed charges8.5110.74
IV - NACL 0.9% [1000 ML]2500370CDM250RCboth11.828.2710.050.85999999999 Percent of total billed charges10.760.91999999999 Percent of total billed charges9.220.78999999999Percent of total billed charges8.870.75999999999Percent of total billed charges10.280.87999999999Percent of total billed charges8.520.721999999999Percent of total billed charges8.5210.76
AUGMENTIN 500/125MG TAB121328CDM250RCboth128.410.20.85999999999 Percent of total billed charges10.920.91999999999 Percent of total billed charges9.360.78999999999Percent of total billed charges90.75999999999Percent of total billed charges10.440.87999999999Percent of total billed charges8.650.721999999999Percent of total billed charges8.6510.92
KEPPRA 1000 MG IVPB2500515CDM250RCboth128.410.20.85999999999 Percent of total billed charges10.920.91999999999 Percent of total billed charges9.360.78999999999Percent of total billed charges90.75999999999Percent of total billed charges10.440.87999999999Percent of total billed charges8.650.721999999999Percent of total billed charges8.6510.92
POTASSIUM 20MEQ/15 ML Oral Sol.120602CDM250RCboth128.410.20.85999999999 Percent of total billed charges10.920.91999999999 Percent of total billed charges9.360.78999999999Percent of total billed charges90.75999999999Percent of total billed charges10.440.87999999999Percent of total billed charges8.650.721999999999Percent of total billed charges8.6510.92
SEROQUEL 25MG TAB121783CDM250RCboth128.410.20.85999999999 Percent of total billed charges10.920.91999999999 Percent of total billed charges9.360.78999999999Percent of total billed charges90.75999999999Percent of total billed charges10.440.87999999999Percent of total billed charges8.650.721999999999Percent of total billed charges8.6510.92
SODIUM CHLORIDE INHALATION 0.9% 3ML121786CDM250RCboth128.410.20.85999999999 Percent of total billed charges10.920.91999999999 Percent of total billed charges9.360.78999999999Percent of total billed charges90.75999999999Percent of total billed charges10.440.87999999999Percent of total billed charges8.650.721999999999Percent of total billed charges8.6510.92
OXYCODONE ER TAB [10 MG]2500330CDM250RCboth12.058.4410.240.85999999999 Percent of total billed charges10.970.91999999999 Percent of total billed charges9.40.78999999999Percent of total billed charges9.040.75999999999Percent of total billed charges10.480.87999999999Percent of total billed charges8.690.721999999999Percent of total billed charges8.6910.97
IV - D5W [1000 ML]2500361CDM250RCboth12.188.5310.350.85999999999 Percent of total billed charges11.080.91999999999 Percent of total billed charges9.50.78999999999Percent of total billed charges9.140.75999999999Percent of total billed charges10.60.87999999999Percent of total billed charges8.780.721999999999Percent of total billed charges8.7811.08
PANTOPRAZOLE **IVPB** 40 MG/NS 100 ML2500406CDM250RCboth12.28.5410.370.85999999999 Percent of total billed charges11.10.91999999999 Percent of total billed charges9.520.78999999999Percent of total billed charges9.150.75999999999Percent of total billed charges10.610.87999999999Percent of total billed charges8.80.721999999999Percent of total billed charges8.811.1
PANTOPRAZOLE INJ [40 MG]2500293CDM250RCboth12.28.5410.370.85999999999 Percent of total billed charges11.10.91999999999 Percent of total billed charges9.520.78999999999Percent of total billed charges9.150.75999999999Percent of total billed charges10.610.87999999999Percent of total billed charges8.80.721999999999Percent of total billed charges8.811.1
IV - D5 NACL [1000 ML]2500362CDM250RCboth12.328.6210.470.85999999999 Percent of total billed charges11.210.91999999999 Percent of total billed charges9.610.78999999999Percent of total billed charges9.240.75999999999Percent of total billed charges10.720.87999999999Percent of total billed charges8.880.721999999999Percent of total billed charges8.8811.21
CEFTAZIDIME **IVPB** 1000 MG/NS 50 ML2500397CDM250RCboth12.488.7410.610.85999999999 Percent of total billed charges11.360.91999999999 Percent of total billed charges9.730.78999999999Percent of total billed charges9.360.75999999999Percent of total billed charges10.860.87999999999Percent of total billed charges90.721999999999Percent of total billed charges911.36
CEFTAZIDIME INJ [1 GM]2500234CDM250RCboth12.488.7410.610.85999999999 Percent of total billed charges11.360.91999999999 Percent of total billed charges9.730.78999999999Percent of total billed charges9.360.75999999999Percent of total billed charges10.860.87999999999Percent of total billed charges90.721999999999Percent of total billed charges911.36
METHOTREXATE TAB [2.5 MG]2500090CDM250RCboth12.488.7410.610.85999999999 Percent of total billed charges11.360.91999999999 Percent of total billed charges9.730.78999999999Percent of total billed charges9.360.75999999999Percent of total billed charges10.860.87999999999Percent of total billed charges90.721999999999Percent of total billed charges911.36
EPINEPHRINE INJ SYR [1 MG/10 ML]2500250CDM250RCboth12.588.8110.690.85999999999 Percent of total billed charges11.450.91999999999 Percent of total billed charges9.810.78999999999Percent of total billed charges9.440.75999999999Percent of total billed charges10.940.87999999999Percent of total billed charges9.070.721999999999Percent of total billed charges9.0711.45
LACTATED RINGERS [1000 ML]2500371CDM250RCboth12.68.8210.710.85999999999 Percent of total billed charges11.470.91999999999 Percent of total billed charges9.830.78999999999Percent of total billed charges9.450.75999999999Percent of total billed charges10.960.87999999999Percent of total billed charges9.080.721999999999Percent of total billed charges9.0811.47
QUETIAPINE TAB [100 MG]2500121CDM250RCboth12.959.0711.010.85999999999 Percent of total billed charges11.780.91999999999 Percent of total billed charges10.10.78999999999Percent of total billed charges9.710.75999999999Percent of total billed charges11.270.87999999999Percent of total billed charges9.340.721999999999Percent of total billed charges9.3411.78
IV - D5 1/2 NACL [1000 ML]2500360CDM250RCboth12.969.0711.020.85999999999 Percent of total billed charges11.790.91999999999 Percent of total billed charges10.110.78999999999Percent of total billed charges9.720.75999999999Percent of total billed charges11.280.87999999999Percent of total billed charges9.340.721999999999Percent of total billed charges9.3411.79
ELIQUIS 2.5MG TAB121957CDM250RCboth139.111.050.85999999999 Percent of total billed charges11.830.91999999999 Percent of total billed charges10.140.78999999999Percent of total billed charges9.750.75999999999Percent of total billed charges11.310.87999999999Percent of total billed charges9.370.721999999999Percent of total billed charges9.3711.83
ARTIFICIAL TEARS2500172CDM250RCboth13.389.3711.370.85999999999 Percent of total billed charges12.180.91999999999 Percent of total billed charges10.440.78999999999Percent of total billed charges10.040.75999999999Percent of total billed charges11.640.87999999999Percent of total billed charges9.650.721999999999Percent of total billed charges9.6512.18
NOREPINEPHRINE INJ [4 MG/4 ML]2500281CDM250RCboth13.489.4411.460.85999999999 Percent of total billed charges12.270.91999999999 Percent of total billed charges10.510.78999999999Percent of total billed charges10.110.75999999999Percent of total billed charges11.730.87999999999Percent of total billed charges9.720.721999999999Percent of total billed charges9.7212.27
CLOPIDOGREL TAB 75 MG2500029CDM250RCboth13.639.5411.590.85999999999 Percent of total billed charges12.40.91999999999 Percent of total billed charges10.630.78999999999Percent of total billed charges10.220.75999999999Percent of total billed charges11.860.87999999999Percent of total billed charges9.830.721999999999Percent of total billed charges9.8312.4
IV - NACL 0.45% [1000 ML]2500369CDM250RCboth13.789.6511.710.85999999999 Percent of total billed charges12.540.91999999999 Percent of total billed charges10.750.78999999999Percent of total billed charges10.340.75999999999Percent of total billed charges11.990.87999999999Percent of total billed charges9.940.721999999999Percent of total billed charges9.9412.54
NAMENDA 10MG TAB121919CDM250RCboth149.811.90.85999999999 Percent of total billed charges12.740.91999999999 Percent of total billed charges10.920.78999999999Percent of total billed charges10.50.75999999999Percent of total billed charges12.180.87999999999Percent of total billed charges10.090.721999999999Percent of total billed charges10.0912.74
CLINDAMYCIN IVPB 900 MG2500519CDM250RCboth14.129.88120.85999999999 Percent of total billed charges12.850.91999999999 Percent of total billed charges11.010.78999999999Percent of total billed charges10.590.75999999999Percent of total billed charges12.280.87999999999Percent of total billed charges10.180.721999999999Percent of total billed charges10.1812.85
FENOFIBRATE TAB [160 MG]2500045CDM250RCboth14.269.9812.120.85999999999 Percent of total billed charges12.980.91999999999 Percent of total billed charges11.120.78999999999Percent of total billed charges10.70.75999999999Percent of total billed charges12.410.87999999999Percent of total billed charges10.280.721999999999Percent of total billed charges10.2812.98
AZITHROMYCIN INJ [500 MG]2500227CDM250RCboth14.6210.2312.430.85999999999 Percent of total billed charges13.30.91999999999 Percent of total billed charges11.40.78999999999Percent of total billed charges10.970.75999999999Percent of total billed charges12.720.87999999999Percent of total billed charges10.540.721999999999Percent of total billed charges10.5413.3
AMOXICILLIN ORAL [400 MG/5 ML]2500211CDM250RCboth14.6610.2612.460.85999999999 Percent of total billed charges13.340.91999999999 Percent of total billed charges11.430.78999999999Percent of total billed charges110.75999999999Percent of total billed charges12.750.87999999999Percent of total billed charges10.570.721999999999Percent of total billed charges10.5713.34
HALOPERIDOL INJ [5 MG/ML]2500249CDM250RCboth14.7410.3212.530.85999999999 Percent of total billed charges13.410.91999999999 Percent of total billed charges11.50.78999999999Percent of total billed charges11.060.75999999999Percent of total billed charges12.820.87999999999Percent of total billed charges10.630.721999999999Percent of total billed charges10.6313.41
AUGMENTIN 875/125MG TAB121329CDM250RCboth1510.512.750.85999999999 Percent of total billed charges13.650.91999999999 Percent of total billed charges11.70.78999999999Percent of total billed charges11.250.75999999999Percent of total billed charges13.050.87999999999Percent of total billed charges10.820.721999999999Percent of total billed charges10.8213.65
NEOSPORIN OINT. 15GM.120538CDM250RCboth1510.512.750.85999999999 Percent of total billed charges13.650.91999999999 Percent of total billed charges11.70.78999999999Percent of total billed charges11.250.75999999999Percent of total billed charges13.050.87999999999Percent of total billed charges10.820.721999999999Percent of total billed charges10.8213.65
NTG 1/150 GR. TAB. 25'S120548CDM250RCboth1510.512.750.85999999999 Percent of total billed charges13.650.91999999999 Percent of total billed charges11.70.78999999999Percent of total billed charges11.250.75999999999Percent of total billed charges13.050.87999999999Percent of total billed charges10.820.721999999999Percent of total billed charges10.8213.65
XARELTO 10MG TAB121947CDM250RCboth1510.512.750.85999999999 Percent of total billed charges13.650.91999999999 Percent of total billed charges11.70.78999999999Percent of total billed charges11.250.75999999999Percent of total billed charges13.050.87999999999Percent of total billed charges10.820.721999999999Percent of total billed charges10.8213.65
DULOXETINE CAP [30 MG]2500044CDM250RCboth15.410.7813.090.85999999999 Percent of total billed charges14.010.91999999999 Percent of total billed charges12.010.78999999999Percent of total billed charges11.550.75999999999Percent of total billed charges13.40.87999999999Percent of total billed charges11.10.721999999999Percent of total billed charges11.114.01
AZITHROMYCIN TAB [250 MG Z-PACK]2500157CDM250RCboth15.5710.913.230.85999999999 Percent of total billed charges14.170.91999999999 Percent of total billed charges12.140.78999999999Percent of total billed charges11.680.75999999999Percent of total billed charges13.550.87999999999Percent of total billed charges11.230.721999999999Percent of total billed charges11.2314.17
DEBROX2500504CDM250RCboth15.6810.9813.330.85999999999 Percent of total billed charges14.270.91999999999 Percent of total billed charges12.230.78999999999Percent of total billed charges11.760.75999999999Percent of total billed charges13.640.87999999999Percent of total billed charges11.310.721999999999Percent of total billed charges11.3114.27
FLUCONAZOLE 100MG TABLET121566CDM250RCboth1611.213.60.85999999999 Percent of total billed charges14.560.91999999999 Percent of total billed charges12.480.78999999999Percent of total billed charges120.75999999999Percent of total billed charges13.920.87999999999Percent of total billed charges11.540.721999999999Percent of total billed charges11.5414.56
THIAMINE INJ [100 MG/ML]2500300CDM250RCboth16.6111.6314.120.85999999999 Percent of total billed charges15.120.91999999999 Percent of total billed charges12.960.78999999999Percent of total billed charges12.460.75999999999Percent of total billed charges14.450.87999999999Percent of total billed charges11.980.721999999999Percent of total billed charges11.9815.12
THIAMINE IVPB2500524CDM250RCboth16.6111.6314.120.85999999999 Percent of total billed charges15.120.91999999999 Percent of total billed charges12.960.78999999999Percent of total billed charges12.460.75999999999Percent of total billed charges14.450.87999999999Percent of total billed charges11.980.721999999999Percent of total billed charges11.9815.12
LIDOCAINE HCL JELLY2500191CDM250RCboth16.811.7614.280.85999999999 Percent of total billed charges15.290.91999999999 Percent of total billed charges13.10.78999999999Percent of total billed charges12.60.75999999999Percent of total billed charges14.620.87999999999Percent of total billed charges12.110.721999999999Percent of total billed charges12.1115.29
AMPICILLIN **IVPB** 1000 MG/NS 50 ML2500393CDM250RCboth17.2712.0914.680.85999999999 Percent of total billed charges15.720.91999999999 Percent of total billed charges13.470.78999999999Percent of total billed charges12.950.75999999999Percent of total billed charges15.020.87999999999Percent of total billed charges12.450.721999999999Percent of total billed charges12.4515.72
AMPICILLIN INJ [1000 MG]2500392CDM250RCboth17.2712.0914.680.85999999999 Percent of total billed charges15.720.91999999999 Percent of total billed charges13.470.78999999999Percent of total billed charges12.950.75999999999Percent of total billed charges15.020.87999999999Percent of total billed charges12.450.721999999999Percent of total billed charges12.4515.72
CYANOCOBALAMIN INJ [1000 MCG/ML]2500239CDM250RCboth17.4812.2414.860.85999999999 Percent of total billed charges15.910.91999999999 Percent of total billed charges13.630.78999999999Percent of total billed charges13.110.75999999999Percent of total billed charges15.210.87999999999Percent of total billed charges12.60.721999999999Percent of total billed charges12.615.91
ENOXAPARIN INJ [30 MG/0.3 ML]2500278CDM250RCboth17.8612.515.180.85999999999 Percent of total billed charges16.250.91999999999 Percent of total billed charges13.930.78999999999Percent of total billed charges13.40.75999999999Percent of total billed charges15.540.87999999999Percent of total billed charges12.880.721999999999Percent of total billed charges12.8816.25
VANCOMYCIN INJ [1 GM]2500305CDM250RCboth1812.615.30.85999999999 Percent of total billed charges16.380.91999999999 Percent of total billed charges14.040.78999999999Percent of total billed charges13.50.75999999999Percent of total billed charges15.660.87999999999Percent of total billed charges12.980.721999999999Percent of total billed charges12.9816.38
IV - D10W [1000 ML]2500363CDM250RCboth18.1212.6815.40.85999999999 Percent of total billed charges16.490.91999999999 Percent of total billed charges14.130.78999999999Percent of total billed charges13.590.75999999999Percent of total billed charges15.760.87999999999Percent of total billed charges13.060.721999999999Percent of total billed charges13.0616.49
TUBERSOL PPD INJ [5 TU/0.1 ML]2500423CDM250RCboth18.4112.8915.650.85999999999 Percent of total billed charges16.750.91999999999 Percent of total billed charges14.360.78999999999Percent of total billed charges13.810.75999999999Percent of total billed charges16.020.87999999999Percent of total billed charges13.270.721999999999Percent of total billed charges13.2716.75
LIDOCAINE INJ SYR [100 MG/5 ML]2500268CDM250RCboth18.8513.216.020.85999999999 Percent of total billed charges17.150.91999999999 Percent of total billed charges14.70.78999999999Percent of total billed charges14.140.75999999999Percent of total billed charges16.40.87999999999Percent of total billed charges13.590.721999999999Percent of total billed charges13.5917.15
DOXYCYCLINE CAP [100 MG]2500464CDM250RCboth19.2313.4616.350.85999999999 Percent of total billed charges17.50.91999999999 Percent of total billed charges150.78999999999Percent of total billed charges14.420.75999999999Percent of total billed charges16.730.87999999999Percent of total billed charges13.860.721999999999Percent of total billed charges13.8617.5
AMIODARONE INJ 450MG/9ML2500587CDM250RCboth2014170.85999999999 Percent of total billed charges18.20.91999999999 Percent of total billed charges15.60.78999999999Percent of total billed charges150.75999999999Percent of total billed charges17.40.87999999999Percent of total billed charges14.420.721999999999Percent of total billed charges14.4218.2
Nafcillin sod inj 2gm2500591CDM250RCboth2014170.85999999999 Percent of total billed charges18.20.91999999999 Percent of total billed charges15.60.78999999999Percent of total billed charges150.75999999999Percent of total billed charges17.40.87999999999Percent of total billed charges14.420.721999999999Percent of total billed charges14.4218.2
TRIAMCINOLONE ACE INJ [40 M/ML]2500264CDM250RCboth20.414.2817.340.85999999999 Percent of total billed charges18.560.91999999999 Percent of total billed charges15.910.78999999999Percent of total billed charges15.30.75999999999Percent of total billed charges17.750.87999999999Percent of total billed charges14.710.721999999999Percent of total billed charges14.7118.56
POTASSIUM CL PACKET [20 MEQ2500142CDM250RCboth20.4114.2917.350.85999999999 Percent of total billed charges18.570.91999999999 Percent of total billed charges15.920.78999999999Percent of total billed charges15.310.75999999999Percent of total billed charges17.760.87999999999Percent of total billed charges14.720.721999999999Percent of total billed charges14.7218.57
PIPERACILLIN/ TAZOBACTAM INJ [3.375 GM]2500312CDM250RCboth20.5214.3617.440.85999999999 Percent of total billed charges18.670.91999999999 Percent of total billed charges16.010.78999999999Percent of total billed charges15.390.75999999999Percent of total billed charges17.850.87999999999Percent of total billed charges14.790.721999999999Percent of total billed charges14.7918.67
PIPERACILLIN/TAZOBACTAM **IVPB** 3.375 G2500410CDM250RCboth20.5214.3617.440.85999999999 Percent of total billed charges18.670.91999999999 Percent of total billed charges16.010.78999999999Percent of total billed charges15.390.75999999999Percent of total billed charges17.850.87999999999Percent of total billed charges14.790.721999999999Percent of total billed charges14.7918.67
PIOGLITAZONE TAB [30 MG]2500109CDM250RCboth21.4114.9918.20.85999999999 Percent of total billed charges19.480.91999999999 Percent of total billed charges16.70.78999999999Percent of total billed charges16.060.75999999999Percent of total billed charges18.630.87999999999Percent of total billed charges15.440.721999999999Percent of total billed charges15.4419.48
ATROPINE INJ [0.1 MG/ML]2500226CDM250RCboth21.615.1218.360.85999999999 Percent of total billed charges19.660.91999999999 Percent of total billed charges16.850.78999999999Percent of total billed charges16.20.75999999999Percent of total billed charges18.790.87999999999Percent of total billed charges15.570.721999999999Percent of total billed charges15.5719.66
OLANZAPINE TAB [5 MG]2500101CDM250RCboth21.7815.2518.510.85999999999 Percent of total billed charges19.820.91999999999 Percent of total billed charges16.990.78999999999Percent of total billed charges16.340.75999999999Percent of total billed charges18.950.87999999999Percent of total billed charges15.70.721999999999Percent of total billed charges15.719.82
DILTIAZEM INJ [125 MG/25 ML]2500425CDM250RCboth21.8415.2918.560.85999999999 Percent of total billed charges19.870.91999999999 Percent of total billed charges17.040.78999999999Percent of total billed charges16.380.75999999999Percent of total billed charges190.87999999999Percent of total billed charges15.750.721999999999Percent of total billed charges15.7519.87
NEO SYNEPHRINE NOSE GTTS121614CDM250RCboth2215.418.70.85999999999 Percent of total billed charges20.020.91999999999 Percent of total billed charges17.160.78999999999Percent of total billed charges16.50.75999999999Percent of total billed charges19.140.87999999999Percent of total billed charges15.860.721999999999Percent of total billed charges15.8620.02
SODIUM POLYSTYRENE SULFON 15GM120446CDM250RCboth2215.418.70.85999999999 Percent of total billed charges20.020.91999999999 Percent of total billed charges17.160.78999999999Percent of total billed charges16.50.75999999999Percent of total billed charges19.140.87999999999Percent of total billed charges15.860.721999999999Percent of total billed charges15.8620.02
TETRACAINE 1/2% OPTH SOL120743CDM250RCboth2215.418.70.85999999999 Percent of total billed charges20.020.91999999999 Percent of total billed charges17.160.78999999999Percent of total billed charges16.50.75999999999Percent of total billed charges19.140.87999999999Percent of total billed charges15.860.721999999999Percent of total billed charges15.8620.02
BUDESONIDE NEB SOLN [0.5 MG/2 ML]2500446CDM250RCboth22.1615.5118.840.85999999999 Percent of total billed charges20.170.91999999999 Percent of total billed charges17.280.78999999999Percent of total billed charges16.620.75999999999Percent of total billed charges19.280.87999999999Percent of total billed charges15.980.721999999999Percent of total billed charges15.9820.17
PIPERACILLIN/TAZOBACTAM **IVPB** 2.25 GM2500409CDM250RCboth22.215.5418.870.85999999999 Percent of total billed charges20.20.91999999999 Percent of total billed charges17.320.78999999999Percent of total billed charges16.650.75999999999Percent of total billed charges19.310.87999999999Percent of total billed charges16.010.721999999999Percent of total billed charges16.0120.2
PIPERACILLIN/TAZOBACTAM INJ [2.25 GM]2500408CDM250RCboth22.215.5418.870.85999999999 Percent of total billed charges20.20.91999999999 Percent of total billed charges17.320.78999999999Percent of total billed charges16.650.75999999999Percent of total billed charges19.310.87999999999Percent of total billed charges16.010.721999999999Percent of total billed charges16.0120.2
ELIQUIS TAB [2.5 MG]2500373CDM250RCboth22.4315.719.070.85999999999 Percent of total billed charges20.410.91999999999 Percent of total billed charges17.50.78999999999Percent of total billed charges16.820.75999999999Percent of total billed charges19.510.87999999999Percent of total billed charges16.170.721999999999Percent of total billed charges16.1720.41
ACTHIB2500428CDM250RCboth22.5815.8119.190.85999999999 Percent of total billed charges20.550.91999999999 Percent of total billed charges17.610.78999999999Percent of total billed charges16.940.75999999999Percent of total billed charges19.640.87999999999Percent of total billed charges16.280.721999999999Percent of total billed charges16.2820.55
MICONAZOLE-7 DAY VAG CREAM2500199CDM250RCboth22.916.0319.470.85999999999 Percent of total billed charges20.840.91999999999 Percent of total billed charges17.860.78999999999Percent of total billed charges17.180.75999999999Percent of total billed charges19.920.87999999999Percent of total billed charges16.510.721999999999Percent of total billed charges16.5120.84
Heparin Sodium 25,000 units per 250 ml122007CDM250RCboth22.9116.0419.470.85999999999 Percent of total billed charges20.850.91999999999 Percent of total billed charges17.870.78999999999Percent of total billed charges17.180.75999999999Percent of total billed charges19.930.87999999999Percent of total billed charges16.520.721999999999Percent of total billed charges16.5220.85
CALCIUM GLUC 10ML INJ220129CDM250RCboth2316.119.550.85999999999 Percent of total billed charges20.930.91999999999 Percent of total billed charges17.940.78999999999Percent of total billed charges17.250.75999999999Percent of total billed charges20.010.87999999999Percent of total billed charges16.580.721999999999Percent of total billed charges16.5820.93
CITROMA 10OZ BTL120163CDM250RCboth2316.119.550.85999999999 Percent of total billed charges20.930.91999999999 Percent of total billed charges17.940.78999999999Percent of total billed charges17.250.75999999999Percent of total billed charges20.010.87999999999Percent of total billed charges16.580.721999999999Percent of total billed charges16.5820.93
IV -POTASSIUM CL/ D5 1/2 NACL [10 MEQ/102500366CDM250RCboth23.316.3119.810.85999999999 Percent of total billed charges21.20.91999999999 Percent of total billed charges18.170.78999999999Percent of total billed charges17.480.75999999999Percent of total billed charges20.270.87999999999Percent of total billed charges16.80.721999999999Percent of total billed charges16.821.2
methylPREDNISolone SUCC [125 MG-2 ML]2500298CDM250RCboth23.3816.3719.870.85999999999 Percent of total billed charges21.280.91999999999 Percent of total billed charges18.240.78999999999Percent of total billed charges17.540.75999999999Percent of total billed charges20.340.87999999999Percent of total billed charges16.860.721999999999Percent of total billed charges16.8621.28
IV -NACL 0.9%/KCL 20 MEQ [1000 ML]2500367CDM250RCboth23.4216.3919.910.85999999999 Percent of total billed charges21.310.91999999999 Percent of total billed charges18.270.78999999999Percent of total billed charges17.570.75999999999Percent of total billed charges20.380.87999999999Percent of total billed charges16.890.721999999999Percent of total billed charges16.8921.31
REFRESH LACRI-LUBE OPHTHALMIC OINT2500178CDM250RCboth23.4416.4119.920.85999999999 Percent of total billed charges21.330.91999999999 Percent of total billed charges18.280.78999999999Percent of total billed charges17.580.75999999999Percent of total billed charges20.390.87999999999Percent of total billed charges16.90.721999999999Percent of total billed charges16.921.33
ENOXAPARIN INJ [40 MG/0.4 ML]2500277CDM250RCboth23.8216.6720.250.85999999999 Percent of total billed charges21.680.91999999999 Percent of total billed charges18.580.78999999999Percent of total billed charges17.870.75999999999Percent of total billed charges20.720.87999999999Percent of total billed charges17.170.721999999999Percent of total billed charges17.1721.68
OCTREOTIDE INJ[100 MCG/ML]2500555CDM250RCboth23.8616.720.280.85999999999 Percent of total billed charges21.710.91999999999 Percent of total billed charges18.610.78999999999Percent of total billed charges17.90.75999999999Percent of total billed charges20.760.87999999999Percent of total billed charges17.20.721999999999Percent of total billed charges17.221.71
Sterile water inh soln 500ml250050CDM250RCboth2416.820.40.85999999999 Percent of total billed charges21.840.91999999999 Percent of total billed charges18.720.78999999999Percent of total billed charges180.75999999999Percent of total billed charges20.880.87999999999Percent of total billed charges17.30.721999999999Percent of total billed charges17.321.84
TOLTERODINE ER TAB [2 MG]2500135CDM250RCboth24.116.8720.490.85999999999 Percent of total billed charges21.930.91999999999 Percent of total billed charges18.80.78999999999Percent of total billed charges18.080.75999999999Percent of total billed charges20.970.87999999999Percent of total billed charges17.380.721999999999Percent of total billed charges17.3821.93
VERAPAMIL INJ [2.5 MG/ML]2500301CDM250RCboth2517.521.250.85999999999 Percent of total billed charges22.750.91999999999 Percent of total billed charges19.50.78999999999Percent of total billed charges18.750.75999999999Percent of total billed charges21.750.87999999999Percent of total billed charges18.030.721999999999Percent of total billed charges18.0322.75
CALIUM CL 10% INJ [10 ML]2500230CDM250RCboth25.0317.5221.280.85999999999 Percent of total billed charges22.780.91999999999 Percent of total billed charges19.520.78999999999Percent of total billed charges18.770.75999999999Percent of total billed charges21.780.87999999999Percent of total billed charges18.050.721999999999Percent of total billed charges18.0522.78
PREGABALIN CAP [75 MG]2500356CDM250RCboth25.4417.8121.620.85999999999 Percent of total billed charges23.150.91999999999 Percent of total billed charges19.840.78999999999Percent of total billed charges19.080.75999999999Percent of total billed charges22.130.87999999999Percent of total billed charges18.340.721999999999Percent of total billed charges18.3423.15
PREGABALIN CAP [50 MG]2500355CDM250RCboth25.4417.8121.620.85999999999 Percent of total billed charges23.150.91999999999 Percent of total billed charges19.840.78999999999Percent of total billed charges19.080.75999999999Percent of total billed charges22.130.87999999999Percent of total billed charges18.340.721999999999Percent of total billed charges18.3423.15
PREGABALIN CAP [100 MG]2500470CDM250RCboth25.4417.8121.620.85999999999 Percent of total billed charges23.150.91999999999 Percent of total billed charges19.840.78999999999Percent of total billed charges19.080.75999999999Percent of total billed charges22.130.87999999999Percent of total billed charges18.340.721999999999Percent of total billed charges18.3423.15
BENZOIN COMPOUND TINCTURE2500187CDM250RCboth25.6717.9721.820.85999999999 Percent of total billed charges23.360.91999999999 Percent of total billed charges20.020.78999999999Percent of total billed charges19.250.75999999999Percent of total billed charges22.330.87999999999Percent of total billed charges18.510.721999999999Percent of total billed charges18.5123.36
OXYTOCIN **IVDRIP** 30 UNITS/NS 500 ML2500405CDM250RCboth25.9218.1422.030.85999999999 Percent of total billed charges23.590.91999999999 Percent of total billed charges20.220.78999999999Percent of total billed charges19.440.75999999999Percent of total billed charges22.550.87999999999Percent of total billed charges18.690.721999999999Percent of total billed charges18.6923.59
SOD BICARB INJ SYR [50 MEQ/50 ML]2500296CDM250RCboth25.9918.1922.090.85999999999 Percent of total billed charges23.650.91999999999 Percent of total billed charges20.270.78999999999Percent of total billed charges19.490.75999999999Percent of total billed charges22.610.87999999999Percent of total billed charges18.740.721999999999Percent of total billed charges18.7423.65
LANTISEPTIC OINT (TUB)121198CDM250RCboth2618.222.10.85999999999 Percent of total billed charges23.660.91999999999 Percent of total billed charges20.280.78999999999Percent of total billed charges19.50.75999999999Percent of total billed charges22.620.87999999999Percent of total billed charges18.750.721999999999Percent of total billed charges18.7523.66
NICOTINE PATCH 14MG121807CDM250RCboth2618.222.10.85999999999 Percent of total billed charges23.660.91999999999 Percent of total billed charges20.280.78999999999Percent of total billed charges19.50.75999999999Percent of total billed charges22.620.87999999999Percent of total billed charges18.750.721999999999Percent of total billed charges18.7523.66
NICOTINE PATCH 21MG120590CDM250RCboth2618.222.10.85999999999 Percent of total billed charges23.660.91999999999 Percent of total billed charges20.280.78999999999Percent of total billed charges19.50.75999999999Percent of total billed charges22.620.87999999999Percent of total billed charges18.750.721999999999Percent of total billed charges18.7523.66
ADENOSINE INJ [6 MG/2 ML]2500228CDM250RCboth26.2818.422.340.85999999999 Percent of total billed charges23.910.91999999999 Percent of total billed charges20.50.78999999999Percent of total billed charges19.710.75999999999Percent of total billed charges22.860.87999999999Percent of total billed charges18.950.721999999999Percent of total billed charges18.9523.91
SUMATRIPTAN INJ [6 MG/0.5 ML]2500262CDM250RCboth26.418.4822.440.85999999999 Percent of total billed charges24.020.91999999999 Percent of total billed charges20.590.78999999999Percent of total billed charges19.80.75999999999Percent of total billed charges22.970.87999999999Percent of total billed charges19.030.721999999999Percent of total billed charges19.0324.02
NYSTATIN SUSPENSION121918CDM250RCboth2718.922.950.85999999999 Percent of total billed charges24.570.91999999999 Percent of total billed charges21.060.78999999999Percent of total billed charges20.250.75999999999Percent of total billed charges23.490.87999999999Percent of total billed charges19.470.721999999999Percent of total billed charges19.4724.57
DEPO-MEDROL INJ [40 MG/ML]2500240CDM250RCboth27.2619.0823.170.85999999999 Percent of total billed charges24.810.91999999999 Percent of total billed charges21.260.78999999999Percent of total billed charges20.450.75999999999Percent of total billed charges23.720.87999999999Percent of total billed charges19.650.721999999999Percent of total billed charges19.6524.81
MEDIHONEY WOUND DRESSING 2"X2"2500478CDM250RCboth27.9819.5923.780.85999999999 Percent of total billed charges25.460.91999999999 Percent of total billed charges21.820.78999999999Percent of total billed charges20.990.75999999999Percent of total billed charges24.340.87999999999Percent of total billed charges20.170.721999999999Percent of total billed charges20.1725.46
OSELTAMIVIR CAP [30 MG]2500170CDM250RCboth28.3619.8524.110.85999999999 Percent of total billed charges25.810.91999999999 Percent of total billed charges22.120.78999999999Percent of total billed charges21.270.75999999999Percent of total billed charges24.670.87999999999Percent of total billed charges20.450.721999999999Percent of total billed charges20.4525.81
CEFEPIME IVPB 2 GM2500517CDM250RCboth28.820.1624.480.85999999999 Percent of total billed charges26.210.91999999999 Percent of total billed charges22.460.78999999999Percent of total billed charges21.60.75999999999Percent of total billed charges25.060.87999999999Percent of total billed charges20.760.721999999999Percent of total billed charges20.7626.21
SILVADENE CR. 50 GM.120670CDM250RCboth2920.324.650.85999999999 Percent of total billed charges26.390.91999999999 Percent of total billed charges22.620.78999999999Percent of total billed charges21.750.75999999999Percent of total billed charges25.230.87999999999Percent of total billed charges20.910.721999999999Percent of total billed charges20.9126.39
Sterile water for inh 1000ml250051CDM250RCboth2920.324.650.85999999999 Percent of total billed charges26.390.91999999999 Percent of total billed charges22.620.78999999999Percent of total billed charges21.750.75999999999Percent of total billed charges25.230.87999999999Percent of total billed charges20.910.721999999999Percent of total billed charges20.9126.39
AZITHROMYCIN **IVPB** 1000 MG/NS 500 ML2500391CDM250RCboth29.2320.4624.850.85999999999 Percent of total billed charges26.60.91999999999 Percent of total billed charges22.80.78999999999Percent of total billed charges21.920.75999999999Percent of total billed charges25.430.87999999999Percent of total billed charges21.070.721999999999Percent of total billed charges21.0726.6
CYCLOPENTOLATE HCL OPHTH [1%]2500174CDM250RCboth29.5420.6825.110.85999999999 Percent of total billed charges26.880.91999999999 Percent of total billed charges23.040.78999999999Percent of total billed charges22.160.75999999999Percent of total billed charges25.70.87999999999Percent of total billed charges21.30.721999999999Percent of total billed charges21.326.88
TETRACAINE HCL OPHTHALMIC 0.5% [4 ML]2500383CDM250RCboth29.9320.9525.440.85999999999 Percent of total billed charges27.240.91999999999 Percent of total billed charges23.350.78999999999Percent of total billed charges22.450.75999999999Percent of total billed charges26.040.87999999999Percent of total billed charges21.580.721999999999Percent of total billed charges21.5827.24
IMIPENEM/CILASTATIN **IVPB** 500-500 MG/2500407CDM250RCboth302125.50.85999999999 Percent of total billed charges27.30.91999999999 Percent of total billed charges23.40.78999999999Percent of total billed charges22.50.75999999999Percent of total billed charges26.10.87999999999Percent of total billed charges21.630.721999999999Percent of total billed charges21.6327.3
IMIPENEM/CILASTATIN INJ [500 MG]2500294CDM250RCboth302125.50.85999999999 Percent of total billed charges27.30.91999999999 Percent of total billed charges23.40.78999999999Percent of total billed charges22.50.75999999999Percent of total billed charges26.10.87999999999Percent of total billed charges21.630.721999999999Percent of total billed charges21.6327.3
LEVETIRACETAM INJ [500 MG/5 ML]2500267CDM250RCboth302125.50.85999999999 Percent of total billed charges27.30.91999999999 Percent of total billed charges23.40.78999999999Percent of total billed charges22.50.75999999999Percent of total billed charges26.10.87999999999Percent of total billed charges21.630.721999999999Percent of total billed charges21.6327.3
LEVOFLOXACIN 500MG TAB121284CDM250RCboth302125.50.85999999999 Percent of total billed charges27.30.91999999999 Percent of total billed charges23.40.78999999999Percent of total billed charges22.50.75999999999Percent of total billed charges26.10.87999999999Percent of total billed charges21.630.721999999999Percent of total billed charges21.6327.3
PREPARATION H OINT 1 OZ120609CDM250RCboth302125.50.85999999999 Percent of total billed charges27.30.91999999999 Percent of total billed charges23.40.78999999999Percent of total billed charges22.50.75999999999Percent of total billed charges26.10.87999999999Percent of total billed charges21.630.721999999999Percent of total billed charges21.6327.3
SILVADENE 1% CREAM [50 GM]2500200CDM250RCboth30.2421.1725.70.85999999999 Percent of total billed charges27.520.91999999999 Percent of total billed charges23.590.78999999999Percent of total billed charges22.680.75999999999Percent of total billed charges26.310.87999999999Percent of total billed charges21.80.721999999999Percent of total billed charges21.827.52
L.E.T GEL2500512CDM250RCboth30.3821.2725.820.85999999999 Percent of total billed charges27.650.91999999999 Percent of total billed charges23.70.78999999999Percent of total billed charges22.790.75999999999Percent of total billed charges26.430.87999999999Percent of total billed charges21.90.721999999999Percent of total billed charges21.927.65
KETAMINE INJ [500 MG/5ML]2500350CDM250RCboth30.5821.4125.990.85999999999 Percent of total billed charges27.830.91999999999 Percent of total billed charges23.850.78999999999Percent of total billed charges22.940.75999999999Percent of total billed charges26.60.87999999999Percent of total billed charges22.050.721999999999Percent of total billed charges22.0527.83
LINCOMYCIN **IVPB** 300 MG/NS 100 ML2500404CDM250RCboth30.6221.4326.030.85999999999 Percent of total billed charges27.860.91999999999 Percent of total billed charges23.880.78999999999Percent of total billed charges22.970.75999999999Percent of total billed charges26.640.87999999999Percent of total billed charges22.080.721999999999Percent of total billed charges22.0827.86
OSELTAMIVIR CAP [75 MG]2500171CDM250RCboth30.9121.6426.270.85999999999 Percent of total billed charges28.130.91999999999 Percent of total billed charges24.110.78999999999Percent of total billed charges23.180.75999999999Percent of total billed charges26.890.87999999999Percent of total billed charges22.290.721999999999Percent of total billed charges22.2928.13
L E T Gel 3ML121976CDM250RCboth3121.726.350.85999999999 Percent of total billed charges28.210.91999999999 Percent of total billed charges24.180.78999999999Percent of total billed charges23.250.75999999999Percent of total billed charges26.970.87999999999Percent of total billed charges22.350.721999999999Percent of total billed charges22.3528.21
TAMIFLU 75MG CAPSULES121911CDM250RCboth3121.726.350.85999999999 Percent of total billed charges28.210.91999999999 Percent of total billed charges24.180.78999999999Percent of total billed charges23.250.75999999999Percent of total billed charges26.970.87999999999Percent of total billed charges22.350.721999999999Percent of total billed charges22.3528.21
AZITHROMYCIN 500MG TAB2500546CDM250RCboth31.1321.7926.460.85999999999 Percent of total billed charges28.330.91999999999 Percent of total billed charges24.280.78999999999Percent of total billed charges23.350.75999999999Percent of total billed charges27.080.87999999999Percent of total billed charges22.440.721999999999Percent of total billed charges22.4428.33
IV - D50W 50% INJ SYR [50 ML]2500242CDM250RCboth31.822.2627.030.85999999999 Percent of total billed charges28.940.91999999999 Percent of total billed charges24.80.78999999999Percent of total billed charges23.850.75999999999Percent of total billed charges27.670.87999999999Percent of total billed charges22.930.721999999999Percent of total billed charges22.9328.94
FLUMAZENIL INJ [0.5 MG/5 ML]2500256CDM250RCboth32.522.7527.630.85999999999 Percent of total billed charges29.580.91999999999 Percent of total billed charges25.350.78999999999Percent of total billed charges24.380.75999999999Percent of total billed charges28.280.87999999999Percent of total billed charges23.430.721999999999Percent of total billed charges23.4329.58
HUMALOG INJ [1 UNITS/0.01 ML]2500437CDM250RCboth32.9623.0728.020.85999999999 Percent of total billed charges29.990.91999999999 Percent of total billed charges25.710.78999999999Percent of total billed charges24.720.75999999999Percent of total billed charges28.680.87999999999Percent of total billed charges23.760.721999999999Percent of total billed charges23.7629.99
DOPAMINE PREMIX [400 MG/250 ML]2500317CDM250RCboth33.1223.1828.150.85999999999 Percent of total billed charges30.140.91999999999 Percent of total billed charges25.830.78999999999Percent of total billed charges24.840.75999999999Percent of total billed charges28.810.87999999999Percent of total billed charges23.880.721999999999Percent of total billed charges23.8830.14
Oseltamivir Phosphate CAP [45 MG]2500379CDM250RCboth33.4423.4128.420.85999999999 Percent of total billed charges30.430.91999999999 Percent of total billed charges26.080.78999999999Percent of total billed charges25.080.75999999999Percent of total billed charges29.090.87999999999Percent of total billed charges24.110.721999999999Percent of total billed charges24.1130.43
LEVOFLOXACIN TAB [500 MG]2500167CDM250RCboth33.6423.5528.590.85999999999 Percent of total billed charges30.610.91999999999 Percent of total billed charges26.240.78999999999Percent of total billed charges25.230.75999999999Percent of total billed charges29.270.87999999999Percent of total billed charges24.250.721999999999Percent of total billed charges24.2530.61
HYDRALAZINE INJ [20 MG/ML]2500261CDM250RCboth34.3624.0529.210.85999999999 Percent of total billed charges31.270.91999999999 Percent of total billed charges26.80.78999999999Percent of total billed charges25.770.75999999999Percent of total billed charges29.890.87999999999Percent of total billed charges24.770.721999999999Percent of total billed charges24.7731.27
ASPART INJ [1 UNITS/0.01 ML]2500439CDM250RCboth34.7224.329.510.85999999999 Percent of total billed charges31.60.91999999999 Percent of total billed charges27.080.78999999999Percent of total billed charges26.040.75999999999Percent of total billed charges30.210.87999999999Percent of total billed charges25.030.721999999999Percent of total billed charges25.0331.6
POLYMIXIN/TRIMETHOPRIM2500183CDM250RCboth34.8424.3929.610.85999999999 Percent of total billed charges31.70.91999999999 Percent of total billed charges27.180.78999999999Percent of total billed charges26.130.75999999999Percent of total billed charges30.310.87999999999Percent of total billed charges25.120.721999999999Percent of total billed charges25.1231.7
MEROPENEM **IVPB** 500 MG/NS 50 ML2500412CDM250RCboth34.9724.4829.720.85999999999 Percent of total billed charges31.820.91999999999 Percent of total billed charges27.280.78999999999Percent of total billed charges26.230.75999999999Percent of total billed charges30.420.87999999999Percent of total billed charges25.210.721999999999Percent of total billed charges25.2131.82
EPINEPHRINE INJ [1 MG/ML]2500248CDM250RCboth3524.529.750.85999999999 Percent of total billed charges31.850.91999999999 Percent of total billed charges27.30.78999999999Percent of total billed charges26.250.75999999999Percent of total billed charges30.450.87999999999Percent of total billed charges25.240.721999999999Percent of total billed charges25.2431.85
FENTANYL 12MCG/HR PATCH121724CDM250RCboth3524.529.750.85999999999 Percent of total billed charges31.850.91999999999 Percent of total billed charges27.30.78999999999Percent of total billed charges26.250.75999999999Percent of total billed charges30.450.87999999999Percent of total billed charges25.240.721999999999Percent of total billed charges25.2431.85
FENTANYL 25MCG/HR PATCH121725CDM250RCboth3524.529.750.85999999999 Percent of total billed charges31.850.91999999999 Percent of total billed charges27.30.78999999999Percent of total billed charges26.250.75999999999Percent of total billed charges30.450.87999999999Percent of total billed charges25.240.721999999999Percent of total billed charges25.2431.85
GLARGINE INJ [1 UNITS/0.01 ML]2500435CDM250RCboth35.0524.5429.790.85999999999 Percent of total billed charges31.90.91999999999 Percent of total billed charges27.340.78999999999Percent of total billed charges26.290.75999999999Percent of total billed charges30.490.87999999999Percent of total billed charges25.270.721999999999Percent of total billed charges25.2731.9
PROMETHAZINE SUPP 12.5 MG2500556CDM250RCboth35.4124.7930.10.85999999999 Percent of total billed charges32.220.91999999999 Percent of total billed charges27.620.78999999999Percent of total billed charges26.560.75999999999Percent of total billed charges30.810.87999999999Percent of total billed charges25.530.721999999999Percent of total billed charges25.5332.22
PROMETHAZINE SUPP 25 MG2500557CDM250RCboth35.4124.7930.10.85999999999 Percent of total billed charges32.220.91999999999 Percent of total billed charges27.620.78999999999Percent of total billed charges26.560.75999999999Percent of total billed charges30.810.87999999999Percent of total billed charges25.530.721999999999Percent of total billed charges25.5332.22
LEVEMIR INJ [1 UNITS/0.01 ML]2500436CDM250RCboth36.9825.8931.430.85999999999 Percent of total billed charges33.650.91999999999 Percent of total billed charges28.840.78999999999Percent of total billed charges27.740.75999999999Percent of total billed charges32.170.87999999999Percent of total billed charges26.660.721999999999Percent of total billed charges26.6633.65
NOREPINEPHRINE 4MG/4ML INJ120467CDM250RCboth3826.632.30.85999999999 Percent of total billed charges34.580.91999999999 Percent of total billed charges29.640.78999999999Percent of total billed charges28.50.75999999999Percent of total billed charges33.060.87999999999Percent of total billed charges27.40.721999999999Percent of total billed charges27.434.58
NYSTATIN SUSP.121620CDM250RCboth3826.632.30.85999999999 Percent of total billed charges34.580.91999999999 Percent of total billed charges29.640.78999999999Percent of total billed charges28.50.75999999999Percent of total billed charges33.060.87999999999Percent of total billed charges27.40.721999999999Percent of total billed charges27.434.58
GENTAMICIN 0.3% OPHTH DROPS2500177CDM250RCboth38.3626.8532.610.85999999999 Percent of total billed charges34.910.91999999999 Percent of total billed charges29.920.78999999999Percent of total billed charges28.770.75999999999Percent of total billed charges33.370.87999999999Percent of total billed charges27.660.721999999999Percent of total billed charges27.6634.91
NEOMYCIN/POLYMIXIN/DEXAMETHASONE OPTH OI2500179CDM250RCboth39.7227.833.760.85999999999 Percent of total billed charges36.150.91999999999 Percent of total billed charges30.980.78999999999Percent of total billed charges29.790.75999999999Percent of total billed charges34.560.87999999999Percent of total billed charges28.640.721999999999Percent of total billed charges28.6436.15
MEDIHONEY TUBE2500193CDM250RCboth4028340.85999999999 Percent of total billed charges36.40.91999999999 Percent of total billed charges31.20.78999999999Percent of total billed charges300.75999999999Percent of total billed charges34.80.87999999999Percent of total billed charges28.840.721999999999Percent of total billed charges28.8436.4
DIAZEPAM CARPUJECT [10 MG/2 ML]2500345CDM250RCboth40.3928.2734.330.85999999999 Percent of total billed charges36.750.91999999999 Percent of total billed charges31.50.78999999999Percent of total billed charges30.290.75999999999Percent of total billed charges35.140.87999999999Percent of total billed charges29.120.721999999999Percent of total billed charges29.1236.75
FENTANYL PATCH [12 MCG/HR]2500468CDM250RCboth40.628.4234.510.85999999999 Percent of total billed charges36.950.91999999999 Percent of total billed charges31.670.78999999999Percent of total billed charges30.450.75999999999Percent of total billed charges35.320.87999999999Percent of total billed charges29.270.721999999999Percent of total billed charges29.2736.95
VECURONIUM BROMIDE INJ [20 MG]2500307CDM250RCboth40.828.5634.680.85999999999 Percent of total billed charges37.130.91999999999 Percent of total billed charges31.820.78999999999Percent of total billed charges30.60.75999999999Percent of total billed charges35.50.87999999999Percent of total billed charges29.420.721999999999Percent of total billed charges29.4237.13
ALENDRONATE TAB 70MG2500012CDM250RCboth40.9828.6934.830.85999999999 Percent of total billed charges37.290.91999999999 Percent of total billed charges31.960.78999999999Percent of total billed charges30.740.75999999999Percent of total billed charges35.650.87999999999Percent of total billed charges29.550.721999999999Percent of total billed charges29.5537.29
INFLUENZA VACCINE2500417CDM250RCboth41.2228.8535.040.85999999999 Percent of total billed charges37.510.91999999999 Percent of total billed charges32.150.78999999999Percent of total billed charges30.920.75999999999Percent of total billed charges35.860.87999999999Percent of total billed charges29.720.721999999999Percent of total billed charges29.7237.51
OFLOXACIN OPHTH 0.3% [5 ML]2500184CDM250RCboth41.8829.3235.60.85999999999 Percent of total billed charges38.110.91999999999 Percent of total billed charges32.670.78999999999Percent of total billed charges31.410.75999999999Percent of total billed charges36.440.87999999999Percent of total billed charges30.20.721999999999Percent of total billed charges30.238.11
PIPERACILLIN /TAZOBACTAM INJ [4.5 G]2500311CDM250RCboth42.1429.535.820.85999999999 Percent of total billed charges38.350.91999999999 Percent of total billed charges32.870.78999999999Percent of total billed charges31.610.75999999999Percent of total billed charges36.660.87999999999Percent of total billed charges30.380.721999999999Percent of total billed charges30.3838.35
PIPERACILLIN/TAZOBACTAM 4.5 GM/NS 100 ML2500411CDM250RCboth42.1429.535.820.85999999999 Percent of total billed charges38.350.91999999999 Percent of total billed charges32.870.78999999999Percent of total billed charges31.610.75999999999Percent of total billed charges36.660.87999999999Percent of total billed charges30.380.721999999999Percent of total billed charges30.3838.35
FENTANYL PATCH 25 MCG2500450CDM250RCboth42.5429.7836.160.85999999999 Percent of total billed charges38.710.91999999999 Percent of total billed charges33.180.78999999999Percent of total billed charges31.910.75999999999Percent of total billed charges37.010.87999999999Percent of total billed charges30.670.721999999999Percent of total billed charges30.6738.71
RIVAROXABAN TAB [10 MG]2500124CDM250RCboth43.430.3836.890.85999999999 Percent of total billed charges39.490.91999999999 Percent of total billed charges33.850.78999999999Percent of total billed charges32.550.75999999999Percent of total billed charges37.760.87999999999Percent of total billed charges31.290.721999999999Percent of total billed charges31.2939.49
ORPHENADRINE INJ [60 MG/2 ML]2500283CDM250RCboth44.4131.0937.750.85999999999 Percent of total billed charges40.410.91999999999 Percent of total billed charges34.640.78999999999Percent of total billed charges33.310.75999999999Percent of total billed charges38.640.87999999999Percent of total billed charges32.020.721999999999Percent of total billed charges32.0240.41
HEPARIN SODIUM/D5W2500313CDM250RCboth4531.538.250.85999999999 Percent of total billed charges40.950.91999999999 Percent of total billed charges35.10.78999999999Percent of total billed charges33.750.75999999999Percent of total billed charges39.150.87999999999Percent of total billed charges32.450.721999999999Percent of total billed charges32.4540.95
SUCCINYLCHOLINE INJ [20 MG/ML]2500427CDM250RCboth46.0332.2239.130.85999999999 Percent of total billed charges41.890.91999999999 Percent of total billed charges35.90.78999999999Percent of total billed charges34.520.75999999999Percent of total billed charges40.050.87999999999Percent of total billed charges33.190.721999999999Percent of total billed charges33.1941.89
ONDANSETRON ODT TAB [4 MG]2500103CDM250RCboth46.2332.3639.30.85999999999 Percent of total billed charges42.070.91999999999 Percent of total billed charges36.060.78999999999Percent of total billed charges34.670.75999999999Percent of total billed charges40.220.87999999999Percent of total billed charges33.330.721999999999Percent of total billed charges33.3342.07
CEPHALEXIN ORAL SOL 250MG/5ML120447CDM250RCboth4732.939.950.85999999999 Percent of total billed charges42.770.91999999999 Percent of total billed charges36.660.78999999999Percent of total billed charges35.250.75999999999Percent of total billed charges40.890.87999999999Percent of total billed charges33.890.721999999999Percent of total billed charges33.8942.77
CHARCOAL/SORBITOL SUSP [50 GM]2500155CDM250RCboth47.333.1140.210.85999999999 Percent of total billed charges43.040.91999999999 Percent of total billed charges36.890.78999999999Percent of total billed charges35.480.75999999999Percent of total billed charges41.150.87999999999Percent of total billed charges34.10.721999999999Percent of total billed charges34.143.04
METHYLPREDNISONE INJ [80 MG/ ML]2500241CDM250RCboth47.3233.1240.220.85999999999 Percent of total billed charges43.060.91999999999 Percent of total billed charges36.910.78999999999Percent of total billed charges35.490.75999999999Percent of total billed charges41.170.87999999999Percent of total billed charges34.120.721999999999Percent of total billed charges34.1243.06
NALOXONE INJ [0.4 MG/ML]2500282CDM250RCboth47.4533.2240.330.85999999999 Percent of total billed charges43.180.91999999999 Percent of total billed charges37.010.78999999999Percent of total billed charges35.590.75999999999Percent of total billed charges41.280.87999999999Percent of total billed charges34.210.721999999999Percent of total billed charges34.2143.18
ONDANSETRON ORAL SOL [4 MG/5 ML]2500223CDM250RCboth47.9633.5740.770.85999999999 Percent of total billed charges43.640.91999999999 Percent of total billed charges37.410.78999999999Percent of total billed charges35.970.75999999999Percent of total billed charges41.730.87999999999Percent of total billed charges34.580.721999999999Percent of total billed charges34.5843.64
FLUCONAZOLE TAB [100 MG]2500166CDM250RCboth4833.640.80.85999999999 Percent of total billed charges43.680.91999999999 Percent of total billed charges37.440.78999999999Percent of total billed charges360.75999999999Percent of total billed charges41.760.87999999999Percent of total billed charges34.610.721999999999Percent of total billed charges34.6143.68
LATANOPROST OPTH DROP2500422CDM250RCboth48.7634.1341.450.85999999999 Percent of total billed charges44.370.91999999999 Percent of total billed charges38.030.78999999999Percent of total billed charges36.570.75999999999Percent of total billed charges42.420.87999999999Percent of total billed charges35.160.721999999999Percent of total billed charges35.1644.37
FENTANYL 50MCG/HR PATCH121419CDM250RCboth4934.341.650.85999999999 Percent of total billed charges44.590.91999999999 Percent of total billed charges38.220.78999999999Percent of total billed charges36.750.75999999999Percent of total billed charges42.630.87999999999Percent of total billed charges35.330.721999999999Percent of total billed charges35.3344.59
MUPIROCIN OINT 2%121169CDM250RCboth4934.341.650.85999999999 Percent of total billed charges44.590.91999999999 Percent of total billed charges38.220.78999999999Percent of total billed charges36.750.75999999999Percent of total billed charges42.630.87999999999Percent of total billed charges35.330.721999999999Percent of total billed charges35.3344.59
NEOMYCIN/POLY/B/HCT OTIC120179CDM250RCboth4934.341.650.85999999999 Percent of total billed charges44.590.91999999999 Percent of total billed charges38.220.78999999999Percent of total billed charges36.750.75999999999Percent of total billed charges42.630.87999999999Percent of total billed charges35.330.721999999999Percent of total billed charges35.3344.59
TRANEXAMIC [100 MG/ML-10ML]2500302CDM250RCboth49.9634.9742.470.85999999999 Percent of total billed charges45.460.91999999999 Percent of total billed charges38.970.78999999999Percent of total billed charges37.470.75999999999Percent of total billed charges43.470.87999999999Percent of total billed charges36.020.721999999999Percent of total billed charges36.0245.46
MUPIROCIN 2% OINT2500192CDM250RCboth503542.50.85999999999 Percent of total billed charges45.50.91999999999 Percent of total billed charges390.78999999999Percent of total billed charges37.50.75999999999Percent of total billed charges43.50.87999999999Percent of total billed charges36.050.721999999999Percent of total billed charges36.0545.5
DEPO-TESTOSTERONE [200 MG/ML]2500353CDM250RCboth50.435.2842.840.85999999999 Percent of total billed charges45.860.91999999999 Percent of total billed charges39.310.78999999999Percent of total billed charges37.80.75999999999Percent of total billed charges43.850.87999999999Percent of total billed charges36.340.721999999999Percent of total billed charges36.3445.86
DOXYCYCLINE **IVPB** 100 MG/NS 100 ml2500402CDM250RCboth50.435.2842.840.85999999999 Percent of total billed charges45.860.91999999999 Percent of total billed charges39.310.78999999999Percent of total billed charges37.80.75999999999Percent of total billed charges43.850.87999999999Percent of total billed charges36.340.721999999999Percent of total billed charges36.3445.86
DOXYCYCLINE INJ [100 MG]2500165CDM250RCboth50.435.2842.840.85999999999 Percent of total billed charges45.860.91999999999 Percent of total billed charges39.310.78999999999Percent of total billed charges37.80.75999999999Percent of total billed charges43.850.87999999999Percent of total billed charges36.340.721999999999Percent of total billed charges36.3445.86
TRANSDERM SCOPALAMINE PATCH [1.0MG/72 HR2500201CDM250RCboth51.1135.7843.440.85999999999 Percent of total billed charges46.510.91999999999 Percent of total billed charges39.870.78999999999Percent of total billed charges38.330.75999999999Percent of total billed charges44.470.87999999999Percent of total billed charges36.850.721999999999Percent of total billed charges36.8546.51
GENTAMICIN OPHT OINT. 3.5GM120369CDM250RCboth5236.444.20.85999999999 Percent of total billed charges47.320.91999999999 Percent of total billed charges40.560.78999999999Percent of total billed charges390.75999999999Percent of total billed charges45.240.87999999999Percent of total billed charges37.490.721999999999Percent of total billed charges37.4947.32
NYSTATIN CREAM [100,000 UNITS/GM]2500195CDM250RCboth52.536.7544.630.85999999999 Percent of total billed charges47.780.91999999999 Percent of total billed charges40.950.78999999999Percent of total billed charges39.380.75999999999Percent of total billed charges45.680.87999999999Percent of total billed charges37.850.721999999999Percent of total billed charges37.8547.78
FENTANYL PATCH [50 MCG/HR]2500322CDM250RCboth52.7236.944.810.85999999999 Percent of total billed charges47.980.91999999999 Percent of total billed charges41.120.78999999999Percent of total billed charges39.540.75999999999Percent of total billed charges45.870.87999999999Percent of total billed charges38.010.721999999999Percent of total billed charges38.0147.98
DOBUTAMINE INJ [250 MG/20 ML]2500309CDM250RCboth53.8837.7245.80.85999999999 Percent of total billed charges49.030.91999999999 Percent of total billed charges42.030.78999999999Percent of total billed charges40.410.75999999999Percent of total billed charges46.880.87999999999Percent of total billed charges38.850.721999999999Percent of total billed charges38.8549.03
DEXTROSE 50% INJ120215CDM250RCboth5437.845.90.85999999999 Percent of total billed charges49.140.91999999999 Percent of total billed charges42.120.78999999999Percent of total billed charges40.50.75999999999Percent of total billed charges46.980.87999999999Percent of total billed charges38.930.721999999999Percent of total billed charges38.9349.14
ACETYLCYSTEINE SOLN 20% [200 MG/ML-10 ML2500036CDM250RCboth54.7738.3446.550.85999999999 Percent of total billed charges49.840.91999999999 Percent of total billed charges42.720.78999999999Percent of total billed charges41.080.75999999999Percent of total billed charges47.650.87999999999Percent of total billed charges39.490.721999999999Percent of total billed charges39.4949.84
TIMOLOL MALEATE SOLUTION [0.25%]2500385CDM250RCboth55.538.8547.180.85999999999 Percent of total billed charges50.510.91999999999 Percent of total billed charges43.290.78999999999Percent of total billed charges41.630.75999999999Percent of total billed charges48.290.87999999999Percent of total billed charges40.020.721999999999Percent of total billed charges40.0250.51
FENTANYL 75MCG/HR PATCH121726CDM250RCboth5639.247.60.85999999999 Percent of total billed charges50.960.91999999999 Percent of total billed charges43.680.78999999999Percent of total billed charges420.75999999999Percent of total billed charges48.720.87999999999Percent of total billed charges40.380.721999999999Percent of total billed charges40.3850.96
LEVOTHYROXINE 100MCG INJ.121749CDM250RCboth5639.247.60.85999999999 Percent of total billed charges50.960.91999999999 Percent of total billed charges43.680.78999999999Percent of total billed charges420.75999999999Percent of total billed charges48.720.87999999999Percent of total billed charges40.380.721999999999Percent of total billed charges40.3850.96
CEPHALEXIN SUSP [250 MG/5 ML-100 ML]2500214CDM250RCboth57.540.2548.880.85999999999 Percent of total billed charges52.330.91999999999 Percent of total billed charges44.850.78999999999Percent of total billed charges43.130.75999999999Percent of total billed charges50.030.87999999999Percent of total billed charges41.460.721999999999Percent of total billed charges41.4652.33
METHYLPREDNISOLONE INJ [500 MG]2500297CDM250RCboth58.2840.849.540.85999999999 Percent of total billed charges53.030.91999999999 Percent of total billed charges45.460.78999999999Percent of total billed charges43.710.75999999999Percent of total billed charges50.70.87999999999Percent of total billed charges42.020.721999999999Percent of total billed charges42.0253.03
CHARCOAL POWDER2500415CDM250RCboth58.8241.17500.85999999999 Percent of total billed charges53.530.91999999999 Percent of total billed charges45.880.78999999999Percent of total billed charges44.120.75999999999Percent of total billed charges51.170.87999999999Percent of total billed charges42.410.721999999999Percent of total billed charges42.4153.53
Influenza vaccine Quad2500584CDM250RCboth6042510.85999999999 Percent of total billed charges54.60.91999999999 Percent of total billed charges46.80.78999999999Percent of total billed charges450.75999999999Percent of total billed charges52.20.87999999999Percent of total billed charges43.260.721999999999Percent of total billed charges43.2654.6
KAYEXALATE SUSP [15 GM/60 ML]2500467CDM250RCboth60.7542.5351.640.85999999999 Percent of total billed charges55.280.91999999999 Percent of total billed charges47.390.78999999999Percent of total billed charges45.560.75999999999Percent of total billed charges52.850.87999999999Percent of total billed charges43.80.721999999999Percent of total billed charges43.855.28
LINCOMYCIN INJ [300 MG/ ML]2500270CDM250RCboth61.2442.8752.050.85999999999 Percent of total billed charges55.730.91999999999 Percent of total billed charges47.770.78999999999Percent of total billed charges45.930.75999999999Percent of total billed charges53.280.87999999999Percent of total billed charges44.150.721999999999Percent of total billed charges44.1555.73
LINCOMYCIN INJ [300 MG/ ML]2500269CDM250RCboth61.2442.8752.050.85999999999 Percent of total billed charges55.730.91999999999 Percent of total billed charges47.770.78999999999Percent of total billed charges45.930.75999999999Percent of total billed charges53.280.87999999999Percent of total billed charges44.150.721999999999Percent of total billed charges44.1555.73
SOD BICARB ADULT 50ML120687CDM250RCboth6243.452.70.85999999999 Percent of total billed charges56.420.91999999999 Percent of total billed charges48.360.78999999999Percent of total billed charges46.50.75999999999Percent of total billed charges53.940.87999999999Percent of total billed charges44.70.721999999999Percent of total billed charges44.756.42
REMDESIVIR 100 MG IVPB2500542CDM250RCboth62.443.6853.040.85999999999 Percent of total billed charges56.780.91999999999 Percent of total billed charges48.670.78999999999Percent of total billed charges46.80.75999999999Percent of total billed charges54.290.87999999999Percent of total billed charges44.990.721999999999Percent of total billed charges44.9956.78
REMDESIVIR 200MG LD2500543CDM250RCboth62.443.6853.040.85999999999 Percent of total billed charges56.780.91999999999 Percent of total billed charges48.670.78999999999Percent of total billed charges46.80.75999999999Percent of total billed charges54.290.87999999999Percent of total billed charges44.990.721999999999Percent of total billed charges44.9956.78
VANCOMYCIN CAP [125 MG]2500382CDM250RCboth62.6143.8353.220.85999999999 Percent of total billed charges56.980.91999999999 Percent of total billed charges48.840.78999999999Percent of total billed charges46.960.75999999999Percent of total billed charges54.470.87999999999Percent of total billed charges45.140.721999999999Percent of total billed charges45.1456.98
FENTANYL 100 MCG/HR PATCH121727CDM250RCboth6545.555.250.85999999999 Percent of total billed charges59.150.91999999999 Percent of total billed charges50.70.78999999999Percent of total billed charges48.750.75999999999Percent of total billed charges56.550.87999999999Percent of total billed charges46.870.721999999999Percent of total billed charges46.8759.15
methylPREDNISolone SUCC INJ [500MG]2500589CDM250RCboth6545.555.250.85999999999 Percent of total billed charges59.150.91999999999 Percent of total billed charges50.70.78999999999Percent of total billed charges48.750.75999999999Percent of total billed charges56.550.87999999999Percent of total billed charges46.870.721999999999Percent of total billed charges46.8759.15
Hepatitis B Vac Recombinant2500430CDM250RCboth65.3645.7555.560.85999999999 Percent of total billed charges59.480.91999999999 Percent of total billed charges50.980.78999999999Percent of total billed charges49.020.75999999999Percent of total billed charges56.860.87999999999Percent of total billed charges47.120.721999999999Percent of total billed charges47.1259.48
AZTREONAM **IVPB** 1000 MG/NS 50 ML2500394CDM250RCboth65.5445.8855.710.85999999999 Percent of total billed charges59.640.91999999999 Percent of total billed charges51.120.78999999999Percent of total billed charges49.160.75999999999Percent of total billed charges57.020.87999999999Percent of total billed charges47.250.721999999999Percent of total billed charges47.2559.64
AZTREONAM INJ [1 GM]2500229CDM250RCboth65.5445.8855.710.85999999999 Percent of total billed charges59.640.91999999999 Percent of total billed charges51.120.78999999999Percent of total billed charges49.160.75999999999Percent of total billed charges57.020.87999999999Percent of total billed charges47.250.721999999999Percent of total billed charges47.2559.64
HYDROXYZINE INJ [50 MG/ML]2500258CDM250RCboth66.3846.4756.420.85999999999 Percent of total billed charges60.410.91999999999 Percent of total billed charges51.780.78999999999Percent of total billed charges49.790.75999999999Percent of total billed charges57.750.87999999999Percent of total billed charges47.860.721999999999Percent of total billed charges47.8660.41
TETANUS, DIPTHERIA VACCINE2500420CDM250RCboth67.1647.0157.090.85999999999 Percent of total billed charges61.120.91999999999 Percent of total billed charges52.380.78999999999Percent of total billed charges50.370.75999999999Percent of total billed charges58.430.87999999999Percent of total billed charges48.420.721999999999Percent of total billed charges48.4261.12
TOBRAMYCIN 0.3% OPTH SOL2500384CDM250RCboth6847.657.80.85999999999 Percent of total billed charges61.880.91999999999 Percent of total billed charges53.040.78999999999Percent of total billed charges510.75999999999Percent of total billed charges59.160.87999999999Percent of total billed charges49.030.721999999999Percent of total billed charges49.0361.88
AZITHROMYCIN SUSP [100 MG/5 ML]2500212CDM250RCboth69.7648.8359.30.85999999999 Percent of total billed charges63.480.91999999999 Percent of total billed charges54.410.78999999999Percent of total billed charges52.320.75999999999Percent of total billed charges60.690.87999999999Percent of total billed charges50.30.721999999999Percent of total billed charges50.363.48
NYSTOP TOPICAL POWDER121460CDM250RCboth704959.50.85999999999 Percent of total billed charges63.70.91999999999 Percent of total billed charges54.60.78999999999Percent of total billed charges52.50.75999999999Percent of total billed charges60.90.87999999999Percent of total billed charges50.470.721999999999Percent of total billed charges50.4763.7
ONDANSETRON ODT TAB [8 MG]2500104CDM250RCboth73.3351.3362.330.85999999999 Percent of total billed charges66.730.91999999999 Percent of total billed charges57.20.78999999999Percent of total billed charges550.75999999999Percent of total billed charges63.80.87999999999Percent of total billed charges52.870.721999999999Percent of total billed charges52.8766.73
ZYPREXA 2.5MG INJ121806CDM250RCboth7552.563.750.85999999999 Percent of total billed charges68.250.91999999999 Percent of total billed charges58.50.78999999999Percent of total billed charges56.250.75999999999Percent of total billed charges65.250.87999999999Percent of total billed charges54.080.721999999999Percent of total billed charges54.0868.25
CEFDINIR SUSP [125 MG/5 ML]2500213CDM250RCboth76.553.5565.030.85999999999 Percent of total billed charges69.620.91999999999 Percent of total billed charges59.670.78999999999Percent of total billed charges57.380.75999999999Percent of total billed charges66.560.87999999999Percent of total billed charges55.160.721999999999Percent of total billed charges55.1669.62
ENOXAPARIN INJ [100 MG/1 ML]2500275CDM250RCboth76.853.7665.280.85999999999 Percent of total billed charges69.890.91999999999 Percent of total billed charges59.90.78999999999Percent of total billed charges57.60.75999999999Percent of total billed charges66.820.87999999999Percent of total billed charges55.370.721999999999Percent of total billed charges55.3769.89
GENTAMICIN 0.3% OPTH OINT2500176CDM250RCboth77.954.5366.220.85999999999 Percent of total billed charges70.890.91999999999 Percent of total billed charges60.760.78999999999Percent of total billed charges58.430.75999999999Percent of total billed charges67.770.87999999999Percent of total billed charges56.170.721999999999Percent of total billed charges56.1770.89
Tdap2500527CDM250RCboth78.9655.2767.120.85999999999 Percent of total billed charges71.850.91999999999 Percent of total billed charges61.590.78999999999Percent of total billed charges59.220.75999999999Percent of total billed charges68.70.87999999999Percent of total billed charges56.930.721999999999Percent of total billed charges56.9371.85
FENTANYL PATCH [75 MCG/HR]2500323CDM250RCboth80.4256.2968.360.85999999999 Percent of total billed charges73.180.91999999999 Percent of total billed charges62.730.78999999999Percent of total billed charges60.320.75999999999Percent of total billed charges69.970.87999999999Percent of total billed charges57.980.721999999999Percent of total billed charges57.9873.18
Nystatin TOPICAL POWDER2500188CDM250RCboth80.7356.5168.620.85999999999 Percent of total billed charges73.460.91999999999 Percent of total billed charges62.970.78999999999Percent of total billed charges60.550.75999999999Percent of total billed charges70.240.87999999999Percent of total billed charges58.210.721999999999Percent of total billed charges58.2173.46
MEDROXYPROGESTERONE ACETA INJ [150 MG/ M2500243CDM250RCboth8156.768.850.85999999999 Percent of total billed charges73.710.91999999999 Percent of total billed charges63.180.78999999999Percent of total billed charges60.750.75999999999Percent of total billed charges70.470.87999999999Percent of total billed charges58.40.721999999999Percent of total billed charges58.473.71
PREDNISOLONE SUSP 1%2500185CDM250RCboth82.9858.0970.530.85999999999 Percent of total billed charges75.510.91999999999 Percent of total billed charges64.720.78999999999Percent of total billed charges62.240.75999999999Percent of total billed charges72.190.87999999999Percent of total billed charges59.830.721999999999Percent of total billed charges59.8375.51
OLANZAPINE INJ [10 MG]2500286CDM250RCboth8358.170.550.85999999999 Percent of total billed charges75.530.91999999999 Percent of total billed charges64.740.78999999999Percent of total billed charges62.250.75999999999Percent of total billed charges72.210.87999999999Percent of total billed charges59.840.721999999999Percent of total billed charges59.8475.53
CLONIDINE PATCH [0.2 MG/24 HR]2500190CDM250RCboth83.7458.6271.180.85999999999 Percent of total billed charges76.20.91999999999 Percent of total billed charges65.320.78999999999Percent of total billed charges62.810.75999999999Percent of total billed charges72.850.87999999999Percent of total billed charges60.380.721999999999Percent of total billed charges60.3876.2
DONNATAL ELIXIR [5 ML]2500216CDM250RCboth85.0559.5472.290.85999999999 Percent of total billed charges77.40.91999999999 Percent of total billed charges66.340.78999999999Percent of total billed charges63.790.75999999999Percent of total billed charges73.990.87999999999Percent of total billed charges61.320.721999999999Percent of total billed charges61.3277.4
NITROGLYCERIN OINTMENT [2%]2500535CDM250RCboth85.1859.6372.40.85999999999 Percent of total billed charges77.510.91999999999 Percent of total billed charges66.440.78999999999Percent of total billed charges63.890.75999999999Percent of total billed charges74.110.87999999999Percent of total billed charges61.410.721999999999Percent of total billed charges61.4177.51
neomycin/bacitracin/polym opth oint2500539CDM250RCboth85.4359.872.620.85999999999 Percent of total billed charges77.740.91999999999 Percent of total billed charges66.640.78999999999Percent of total billed charges64.070.75999999999Percent of total billed charges74.320.87999999999Percent of total billed charges61.60.721999999999Percent of total billed charges61.677.74
ATROPINE SULFATE OPHTH [1%]2500173CDM250RCboth87.5761.374.430.85999999999 Percent of total billed charges79.690.91999999999 Percent of total billed charges68.30.78999999999Percent of total billed charges65.680.75999999999Percent of total billed charges76.190.87999999999Percent of total billed charges63.140.721999999999Percent of total billed charges63.1479.69
PHYTONADIONE INJ [1 MG/0.5 ML]2500308CDM250RCboth88.1461.774.920.85999999999 Percent of total billed charges80.210.91999999999 Percent of total billed charges68.750.78999999999Percent of total billed charges66.110.75999999999Percent of total billed charges76.680.87999999999Percent of total billed charges63.550.721999999999Percent of total billed charges63.5580.21
FLUZONE HIGH-DOSE PF 20192500418CDM250RCboth88.4361.975.170.85999999999 Percent of total billed charges80.470.91999999999 Percent of total billed charges68.980.78999999999Percent of total billed charges66.320.75999999999Percent of total billed charges76.930.87999999999Percent of total billed charges63.760.721999999999Percent of total billed charges63.7680.47
ACETAMINOPHEN IVPB 1000MG/100ML2500553CDM250RCboth88.8262.1775.50.85999999999 Percent of total billed charges80.830.91999999999 Percent of total billed charges69.280.78999999999Percent of total billed charges66.620.75999999999Percent of total billed charges77.270.87999999999Percent of total billed charges64.040.721999999999Percent of total billed charges64.0480.83
SULFACETAMIDE SOD 10% OPTH SOL2500181CDM250RCboth91.564.0577.780.85999999999 Percent of total billed charges83.270.91999999999 Percent of total billed charges71.370.78999999999Percent of total billed charges68.630.75999999999Percent of total billed charges79.610.87999999999Percent of total billed charges65.970.721999999999Percent of total billed charges65.9783.27
CLINDAMYCIN PALMITATE HCL [75 MG/5ML]2500215CDM250RCboth93.0465.1379.080.85999999999 Percent of total billed charges84.670.91999999999 Percent of total billed charges72.570.78999999999Percent of total billed charges69.780.75999999999Percent of total billed charges80.940.87999999999Percent of total billed charges67.080.721999999999Percent of total billed charges67.0884.67
HYDROCORTISONE SUCCINATE [100 MG]2500299CDM250RCboth93.2865.379.290.85999999999 Percent of total billed charges84.880.91999999999 Percent of total billed charges72.760.78999999999Percent of total billed charges69.960.75999999999Percent of total billed charges81.150.87999999999Percent of total billed charges67.250.721999999999Percent of total billed charges67.2584.88
FLUTICASONE NASAL SPRAY121394CDM250RCboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges69.2287.36
DTAP2500431CDM250RCboth99.5369.6784.60.85999999999 Percent of total billed charges90.570.91999999999 Percent of total billed charges77.630.78999999999Percent of total billed charges74.650.75999999999Percent of total billed charges86.590.87999999999Percent of total billed charges71.760.721999999999Percent of total billed charges71.7690.57
VECURONIUM BROMIDE INJ [10 MG/ML]2500306CDM250RCboth102.4271.6987.060.85999999999 Percent of total billed charges93.20.91999999999 Percent of total billed charges79.890.78999999999Percent of total billed charges76.820.75999999999Percent of total billed charges89.110.87999999999Percent of total billed charges73.840.721999999999Percent of total billed charges73.8493.2
VENTOLIN HFA2500536CDM250RCboth102.6371.8487.240.85999999999 Percent of total billed charges93.390.91999999999 Percent of total billed charges80.050.78999999999Percent of total billed charges76.970.75999999999Percent of total billed charges89.290.87999999999Percent of total billed charges740.721999999999Percent of total billed charges7493.39
PRO AIR HFA (ALBUTEROL SULFATE121892CDM250RCboth10472.888.40.85999999999 Percent of total billed charges94.640.91999999999 Percent of total billed charges81.120.78999999999Percent of total billed charges780.75999999999Percent of total billed charges90.480.87999999999Percent of total billed charges74.980.721999999999Percent of total billed charges74.9894.64
Voltaven 1% gel122013CDM250RCboth112.3878.6795.520.85999999999 Percent of total billed charges102.270.91999999999 Percent of total billed charges87.660.78999999999Percent of total billed charges84.290.75999999999Percent of total billed charges97.770.87999999999Percent of total billed charges81.030.721999999999Percent of total billed charges81.03102.27
FENTANYL PATCH [100 MCG/HR]2500324CDM250RCboth118.0682.64100.350.85999999999 Percent of total billed charges107.430.91999999999 Percent of total billed charges92.090.78999999999Percent of total billed charges88.550.75999999999Percent of total billed charges102.710.87999999999Percent of total billed charges85.120.721999999999Percent of total billed charges85.12107.43
AZMACORT INHALER121107CDM250RCboth12587.5106.250.85999999999 Percent of total billed charges113.750.91999999999 Percent of total billed charges97.50.78999999999Percent of total billed charges93.750.75999999999Percent of total billed charges108.750.87999999999Percent of total billed charges90.130.721999999999Percent of total billed charges90.13113.75
Thrombin, Topical 5,000 IU122011CDM250RCboth12587.5106.250.85999999999 Percent of total billed charges113.750.91999999999 Percent of total billed charges97.50.78999999999Percent of total billed charges93.750.75999999999Percent of total billed charges108.750.87999999999Percent of total billed charges90.130.721999999999Percent of total billed charges90.13113.75
FLUTICASONE PROPIONATE NASAL SPRAY [50 M2500442CDM250RCboth126.4888.54107.510.85999999999 Percent of total billed charges115.10.91999999999 Percent of total billed charges98.650.78999999999Percent of total billed charges94.860.75999999999Percent of total billed charges110.040.87999999999Percent of total billed charges91.190.721999999999Percent of total billed charges91.19115.1
CADEXOMER IODINE GEL2500208CDM250RCboth128.2589.78109.010.85999999999 Percent of total billed charges116.710.91999999999 Percent of total billed charges100.040.78999999999Percent of total billed charges96.190.75999999999Percent of total billed charges111.580.87999999999Percent of total billed charges92.470.721999999999Percent of total billed charges92.47116.71
PROAIR2500447CDM250RCboth131.9492.36112.150.85999999999 Percent of total billed charges120.070.91999999999 Percent of total billed charges102.910.78999999999Percent of total billed charges98.960.75999999999Percent of total billed charges114.790.87999999999Percent of total billed charges95.130.721999999999Percent of total billed charges95.13120.07
DICYCLOMINE HCL INJ [ 20 MG/2 ML]2500245CDM250RCboth136.1895.33115.750.85999999999 Percent of total billed charges123.920.91999999999 Percent of total billed charges106.220.78999999999Percent of total billed charges102.140.75999999999Percent of total billed charges118.480.87999999999Percent of total billed charges98.190.721999999999Percent of total billed charges98.19123.92
Novolog 100 un/ml122012CDM250RCboth140981190.85999999999 Percent of total billed charges127.40.91999999999 Percent of total billed charges109.20.78999999999Percent of total billed charges1050.75999999999Percent of total billed charges121.80.87999999999Percent of total billed charges100.940.721999999999Percent of total billed charges100.94127.4
FLUZONE QUANRIVALENT2500419CDM250RCboth140.4398.3119.370.85999999999 Percent of total billed charges127.790.91999999999 Percent of total billed charges109.540.78999999999Percent of total billed charges105.320.75999999999Percent of total billed charges122.170.87999999999Percent of total billed charges101.250.721999999999Percent of total billed charges101.25127.79
NEOMYCIN/POLYMIXIN/HYDROCORTISONE OTIC S2500180CDM250RCboth157.32110.12133.720.85999999999 Percent of total billed charges143.160.91999999999 Percent of total billed charges122.710.78999999999Percent of total billed charges117.990.75999999999Percent of total billed charges136.870.87999999999Percent of total billed charges113.430.721999999999Percent of total billed charges113.43143.16
M-M-R2500513CDM250RCboth161.08112.76136.920.85999999999 Percent of total billed charges146.580.91999999999 Percent of total billed charges125.640.78999999999Percent of total billed charges120.810.75999999999Percent of total billed charges140.140.87999999999Percent of total billed charges116.140.721999999999Percent of total billed charges116.14146.58
COMBIVENT INHALER121403CDM250RCboth165115.5140.250.85999999999 Percent of total billed charges150.150.91999999999 Percent of total billed charges128.70.78999999999Percent of total billed charges123.750.75999999999Percent of total billed charges143.550.87999999999Percent of total billed charges118.970.721999999999Percent of total billed charges118.97150.15
SPIRIVA INHALER121492CDM250RCboth192134.4163.20.85999999999 Percent of total billed charges174.720.91999999999 Percent of total billed charges149.760.78999999999Percent of total billed charges1440.75999999999Percent of total billed charges167.040.87999999999Percent of total billed charges138.430.721999999999Percent of total billed charges138.43174.72
ERTAPENEM **IVPB** 1000 MG/NS 50 ML2500403CDM250RCboth210.73147.51179.120.85999999999 Percent of total billed charges191.760.91999999999 Percent of total billed charges164.370.78999999999Percent of total billed charges158.050.75999999999Percent of total billed charges183.340.87999999999Percent of total billed charges151.940.721999999999Percent of total billed charges151.94191.76
ERTEPENEM INJ [1 GM]2500263CDM250RCboth210.73147.51179.120.85999999999 Percent of total billed charges191.760.91999999999 Percent of total billed charges164.370.78999999999Percent of total billed charges158.050.75999999999Percent of total billed charges183.340.87999999999Percent of total billed charges151.940.721999999999Percent of total billed charges151.94191.76
PNEUMOVAX 23 INJ 25 MCG/0.5 ML2500416CDM250RCboth210.75147.53179.140.85999999999 Percent of total billed charges191.780.91999999999 Percent of total billed charges164.390.78999999999Percent of total billed charges158.060.75999999999Percent of total billed charges183.350.87999999999Percent of total billed charges151.950.721999999999Percent of total billed charges151.95191.78
CORTROSYN 0.25MG120039CDM250RCboth222155.4188.70.85999999999 Percent of total billed charges202.020.91999999999 Percent of total billed charges173.160.78999999999Percent of total billed charges166.50.75999999999Percent of total billed charges193.140.87999999999Percent of total billed charges160.060.721999999999Percent of total billed charges160.06202.02
Novavax Vaccine2500586CDM250RCboth225157.5191.250.85999999999 Percent of total billed charges204.750.91999999999 Percent of total billed charges175.50.78999999999Percent of total billed charges168.750.75999999999Percent of total billed charges195.750.87999999999Percent of total billed charges162.230.721999999999Percent of total billed charges162.23204.75
HYDROCORTISONE ACETATE/PR2500194CDM250RCboth243.57170.5207.030.85999999999 Percent of total billed charges221.650.91999999999 Percent of total billed charges189.980.78999999999Percent of total billed charges182.680.75999999999Percent of total billed charges211.910.87999999999Percent of total billed charges175.610.721999999999Percent of total billed charges175.61221.65
OSELTAMIVIR PHOSPHATE SUSPENSION [6 MG/2500380CDM250RCboth246.04172.23209.130.85999999999 Percent of total billed charges223.90.91999999999 Percent of total billed charges191.910.78999999999Percent of total billed charges184.530.75999999999Percent of total billed charges214.050.87999999999Percent of total billed charges177.390.721999999999Percent of total billed charges177.39223.9
NEOMYCIN/POLYMYXIN/HYDROC OPTH.2500182CDM250RCboth255.38178.77217.070.85999999999 Percent of total billed charges232.40.91999999999 Percent of total billed charges199.20.78999999999Percent of total billed charges191.540.75999999999Percent of total billed charges222.180.87999999999Percent of total billed charges184.130.721999999999Percent of total billed charges184.13232.4
HYDROCORTISONE INJ [1000 MG]2500292CDM250RCboth258.9181.23220.070.85999999999 Percent of total billed charges235.60.91999999999 Percent of total billed charges201.940.78999999999Percent of total billed charges194.180.75999999999Percent of total billed charges225.240.87999999999Percent of total billed charges186.670.721999999999Percent of total billed charges186.67235.6
SANTYL OINT 30GR121486CDM250RCboth261182.7221.850.85999999999 Percent of total billed charges237.510.91999999999 Percent of total billed charges203.580.78999999999Percent of total billed charges195.750.75999999999Percent of total billed charges227.070.87999999999Percent of total billed charges188.180.721999999999Percent of total billed charges188.18237.51
famotidine sus [40mg/5ml]2500217CDM250RCboth265.42185.79225.610.85999999999 Percent of total billed charges241.530.91999999999 Percent of total billed charges207.030.78999999999Percent of total billed charges199.070.75999999999Percent of total billed charges230.920.87999999999Percent of total billed charges191.370.721999999999Percent of total billed charges191.37241.53
LINEZOLID TAB [600 MG]2500079CDM250RCboth274.5192.15233.330.85999999999 Percent of total billed charges249.80.91999999999 Percent of total billed charges214.110.78999999999Percent of total billed charges205.880.75999999999Percent of total billed charges238.820.87999999999Percent of total billed charges197.910.721999999999Percent of total billed charges197.91249.8
ALTEPHLASE INJ 2 MG2500571CDM250RCboth302.31211.62256.960.85999999999 Percent of total billed charges275.10.91999999999 Percent of total billed charges235.80.78999999999Percent of total billed charges226.730.75999999999Percent of total billed charges263.010.87999999999Percent of total billed charges217.970.721999999999Percent of total billed charges217.97275.1
RABIES VACCINE PCEC [2.5 UNIT] SYG KIT2500554CDM250RCboth433.19303.23368.210.85999999999 Percent of total billed charges394.20.91999999999 Percent of total billed charges337.890.78999999999Percent of total billed charges324.890.75999999999Percent of total billed charges376.880.87999999999Percent of total billed charges312.330.721999999999Percent of total billed charges312.33394.2
ACETYLCYSTEINE 200MG/ML121866CDM250RCboth448313.6380.80.85999999999 Percent of total billed charges407.680.91999999999 Percent of total billed charges349.440.78999999999Percent of total billed charges3360.75999999999Percent of total billed charges389.760.87999999999Percent of total billed charges323.010.721999999999Percent of total billed charges323.01407.68
PROCRIT INJ 10000 UNITS2500576CDM250RCboth481.05336.74408.890.85999999999 Percent of total billed charges437.760.91999999999 Percent of total billed charges375.220.78999999999Percent of total billed charges360.790.75999999999Percent of total billed charges418.510.87999999999Percent of total billed charges346.840.721999999999Percent of total billed charges346.84437.76
GLUCAGON KIT [1 MG]2500253CDM250RCboth505.44353.81429.620.85999999999 Percent of total billed charges459.950.91999999999 Percent of total billed charges394.240.78999999999Percent of total billed charges379.080.75999999999Percent of total billed charges439.730.87999999999Percent of total billed charges364.420.721999999999Percent of total billed charges364.42459.95
MENACTRA2500429CDM250RCboth535.04374.53454.780.85999999999 Percent of total billed charges486.890.91999999999 Percent of total billed charges417.330.78999999999Percent of total billed charges401.280.75999999999Percent of total billed charges465.480.87999999999Percent of total billed charges385.760.721999999999Percent of total billed charges385.76486.89
PENICILLIN G BENZ INJ [1.2 MILLION UNIT/2500432CDM250RCboth550385467.50.85999999999 Percent of total billed charges500.50.91999999999 Percent of total billed charges4290.78999999999Percent of total billed charges412.50.75999999999Percent of total billed charges478.50.87999999999Percent of total billed charges396.550.721999999999Percent of total billed charges396.55500.5
Advair Diskus 250/50mcg2500537CDM250RCboth666.54466.58566.560.85999999999 Percent of total billed charges606.550.91999999999 Percent of total billed charges519.90.78999999999Percent of total billed charges499.910.75999999999Percent of total billed charges579.890.87999999999Percent of total billed charges480.580.721999999999Percent of total billed charges480.58606.55
DAPTOMYCIN INJ [500 MG]2500426CDM250RCboth801.88561.32681.60.85999999999 Percent of total billed charges729.710.91999999999 Percent of total billed charges625.470.78999999999Percent of total billed charges601.410.75999999999Percent of total billed charges697.640.87999999999Percent of total billed charges578.160.721999999999Percent of total billed charges578.16729.71
COMBIVENT INHALER 20MCG/100MCG2500560CDM250RCboth855.16598.61726.890.85999999999 Percent of total billed charges778.20.91999999999 Percent of total billed charges667.020.78999999999Percent of total billed charges641.370.75999999999Percent of total billed charges743.990.87999999999Percent of total billed charges616.570.721999999999Percent of total billed charges616.57778.2
DAPTOmycin **IVPB** [800 MG/50 ML]2500572CDM250RCboth1283.02898.111090.570.85999999999 Percent of total billed charges1167.550.91999999999 Percent of total billed charges1000.760.78999999999Percent of total billed charges962.270.75999999999Percent of total billed charges1116.230.87999999999Percent of total billed charges925.060.721999999999Percent of total billed charges925.061167.55
CROFAB2500421CDM250RCboth5756.44029.484892.940.85999999999 Percent of total billed charges5238.320.91999999999 Percent of total billed charges4489.990.78999999999Percent of total billed charges4317.30.75999999999Percent of total billed charges5008.070.87999999999Percent of total billed charges4150.360.721999999999Percent of total billed charges4150.365238.32
ALTEPLASE INJ [100 MG]2500388CDM250RCboth15840.6411088.4513464.540.85999999999 Percent of total billed charges14414.980.91999999999 Percent of total billed charges12355.70.78999999999Percent of total billed charges11880.480.75999999999Percent of total billed charges13781.360.87999999999Percent of total billed charges11421.10.721999999999Percent of total billed charges11421.114414.98
CLEOCIN 300MG220168CDM259RCS0077CPTboth3625.230.60.85999999999 Percent of total billed charges32.760.91999999999 Percent of total billed charges28.080.78999999999Percent of total billed charges2.09999999999Fee schedule270.75999999999Percent of total billed charges31.320.87999999999Percent of total billed charges25.960.721999999999Percent of total billed charges2.0932.76
LANTISEPTIC OINT PACKAGE221198CDM259RCboth21.41.70.85999999999 Percent of total billed charges1.820.91999999999 Percent of total billed charges1.560.78999999999Percent of total billed charges1.50.75999999999Percent of total billed charges1.740.87999999999Percent of total billed charges1.440.721999999999Percent of total billed charges1.441.82
INSULIN HUMULIN NPH 100U220426CDM259RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
HYDRATION INFUSION THERAPY INT HR7094CDM260RC96360CPTboth2001401700.85999999999 Percent of total billed charges1820.91999999999 Percent of total billed charges169.66999999999Fee schedule177.38999999999Fee schedule192.8999999999Fee schedule192.8999999999Fee schedule1560.78999999999Percent of total billed charges81.57999999999Fee schedule1500.75999999999Percent of total billed charges1740.87999999999Percent of total billed charges144.20.721999999999Percent of total billed charges81.57192.8
HYDRATION INFUSION THERAPY EA ADDL HR7095CDM260RC96361CPTboth704959.50.85999999999 Percent of total billed charges63.70.91999999999 Percent of total billed charges60.24999999999Fee schedule62.97999999999Fee schedule68.45999999999Fee schedule68.45999999999Fee schedule54.60.78999999999Percent of total billed charges24.38999999999Fee schedule52.50.75999999999Percent of total billed charges60.90.87999999999Percent of total billed charges50.470.721999999999Percent of total billed charges24.3868.45
IV Infusion INITIAL HR7096CDM260RC96365CPTboth445311.5378.250.85999999999 Percent of total billed charges404.950.91999999999 Percent of total billed charges320.32999999999Fee schedule334.88999999999Fee schedule364999999999Fee schedule364999999999Fee schedule347.10.78999999999Percent of total billed charges99.1999999999Fee schedule333.750.75999999999Percent of total billed charges387.150.87999999999Percent of total billed charges320.850.721999999999Percent of total billed charges99.1404.95
IV Infusion ADDL HR7097CDM260RC96366CPTboth1107793.50.85999999999 Percent of total billed charges100.10.91999999999 Percent of total billed charges999999999Fee schedule999999999Fee schedule999999999Fee schedule999999999Fee schedule85.80.78999999999Percent of total billed charges32.62999999999Fee schedule82.50.75999999999Percent of total billed charges95.70.87999999999Percent of total billed charges79.310.721999999999Percent of total billed charges32.62100.1
IV Infusion add new drug up to 1 hr.96367CDM260RC96367CPTboth1801261530.85999999999 Percent of total billed charges163.80.91999999999 Percent of total billed charges139.52999999999Fee schedule145.87999999999Fee schedule158.55999999999Fee schedule158.55999999999Fee schedule140.40.78999999999Percent of total billed charges50.45999999999Fee schedule1350.75999999999Percent of total billed charges156.60.87999999999Percent of total billed charges129.780.721999999999Percent of total billed charges50.45163.8
IV Infusion, concurrent96368CDM260RC96368CPTboth1107793.50.85999999999 Percent of total billed charges100.10.91999999999 Percent of total billed charges93.54999999999Fee schedule97.8999999999Fee schedule106.3999999999Fee schedule106.3999999999Fee schedule85.80.78999999999Percent of total billed charges30.53999999999Fee schedule82.50.75999999999Percent of total billed charges95.70.87999999999Percent of total billed charges79.310.721999999999Percent of total billed charges30.53106.3
INTRA-ARTERIAL7032CDM260RC96373CPTboth10070850.85999999999 Percent of total billed charges910.91999999999 Percent of total billed charges84.04999999999Fee schedule87.86999999999Fee schedule95.5999999999Fee schedule95.5999999999Fee schedule780.78999999999Percent of total billed charges18.4999999999Fee schedule750.75999999999Percent of total billed charges870.87999999999Percent of total billed charges72.10.721999999999Percent of total billed charges18.495.5
IV PUSH single or Initial121359CDM260RC96374CPTboth2001401700.85999999999 Percent of total billed charges1820.91999999999 Percent of total billed charges174.42999999999Fee schedule182.34999999999Fee schedule198.2999999999Fee schedule198.2999999999Fee schedule1560.78999999999Percent of total billed charges78.27999999999Fee schedule1500.75999999999Percent of total billed charges1740.87999999999Percent of total billed charges144.20.721999999999Percent of total billed charges78.27198.2
EACH ADDITIONAL/IV PUSH (new drug)7090CDM260RC96375CPTboth8559.572.250.85999999999 Percent of total billed charges77.350.91999999999 Percent of total billed charges74.54999999999Fee schedule77.92999999999Fee schedule84.7999999999Fee schedule84.7999999999Fee schedule66.30.78999999999Percent of total billed charges34.61999999999Fee schedule63.750.75999999999Percent of total billed charges73.950.87999999999Percent of total billed charges61.290.721999999999Percent of total billed charges34.6184.7
IV Push ea add same drug96376CDM260RC96376CPTboth12587.5106.250.85999999999 Percent of total billed charges113.750.91999999999 Percent of total billed charges104.68999999999Fee schedule109.43999999999Fee schedule118.95999999999Fee schedule118.95999999999Fee schedule97.50.78999999999Percent of total billed charges93.750.75999999999Percent of total billed charges108.750.87999999999Percent of total billed charges90.130.721999999999Percent of total billed charges90.13118.95
NSS 1000CC6012CDM260RCJ7030CPTboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges2.08999999999Fee schedule720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges2.0887.36
NS 50CC6034CDM260RCJ7050CPTboth8056680.85999999999 Percent of total billed charges72.80.91999999999 Percent of total billed charges62.40.78999999999Percent of total billed charges2.96999999999Fee schedule600.75999999999Percent of total billed charges69.60.87999999999Percent of total billed charges57.680.721999999999Percent of total billed charges2.9672.8
NS 100CC6003CDM260RCJ7050CPTboth8458.871.40.85999999999 Percent of total billed charges76.440.91999999999 Percent of total billed charges65.520.78999999999Percent of total billed charges2.96999999999Fee schedule630.75999999999Percent of total billed charges73.080.87999999999Percent of total billed charges60.560.721999999999Percent of total billed charges2.9676.44
NS 250CC6030CDM260RCJ7050CPTboth8861.674.80.85999999999 Percent of total billed charges80.080.91999999999 Percent of total billed charges68.640.78999999999Percent of total billed charges2.96999999999Fee schedule660.75999999999Percent of total billed charges76.560.87999999999Percent of total billed charges63.450.721999999999Percent of total billed charges2.9680.08
NS W/20 MEQ KCL (1000ML)6050CDM260RCJ7050CPTboth9264.478.20.85999999999 Percent of total billed charges83.720.91999999999 Percent of total billed charges71.760.78999999999Percent of total billed charges2.96999999999Fee schedule690.75999999999Percent of total billed charges80.040.87999999999Percent of total billed charges66.330.721999999999Percent of total billed charges2.9683.72
NSS 500CC6011CDM260RCJ7050CPTboth9264.478.20.85999999999 Percent of total billed charges83.720.91999999999 Percent of total billed charges71.760.78999999999Percent of total billed charges2.96999999999Fee schedule690.75999999999Percent of total billed charges80.040.87999999999Percent of total billed charges66.330.721999999999Percent of total billed charges2.9683.72
D5W NS 1000CC6009CDM260RCJ7070CPTboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges2.02999999999Fee schedule720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges2.0287.36
LR 1000CC6016CDM260RCJ7120CPTboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges6.7999999999Fee schedule720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges6.787.36
Regen Cov Infusion/SubQ260001CDM260RCM0243CPTboth950665807.50.85999999999 Percent of total billed charges864.50.91999999999 Percent of total billed charges1980999999999Fee schedule2070999999999Fee schedule2250999999999Fee schedule2250999999999Fee schedule7410.78999999999Percent of total billed charges712.50.75999999999Percent of total billed charges826.50.87999999999Percent of total billed charges684.950.721999999999Percent of total billed charges684.952250
EXTENSION SET6021CDM260RCQ0081CPTboth12.58.7510.630.85999999999 Percent of total billed charges11.380.91999999999 Percent of total billed charges9.750.78999999999Percent of total billed charges12.5999999999Fee schedule9.380.75999999999Percent of total billed charges10.880.87999999999Percent of total billed charges9.010.721999999999Percent of total billed charges9.0112.5
D10W 1000CC6023CDM260RCQ0081CPTboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges70999999999Fee schedule720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges69.2287.36
Saline Irrig 250ml6056CDM260RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
Sterile water 1mg 250ml6055CDM260RCboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.335.46
EXTENSION SET 4WAY6042CDM260RCboth7.55.256.380.85999999999 Percent of total billed charges6.830.91999999999 Percent of total billed charges5.850.78999999999Percent of total billed charges5.630.75999999999Percent of total billed charges6.530.87999999999Percent of total billed charges5.410.721999999999Percent of total billed charges5.416.83
BURETROL REG. DRIP6017CDM260RCboth2014170.85999999999 Percent of total billed charges18.20.91999999999 Percent of total billed charges15.60.78999999999Percent of total billed charges150.75999999999Percent of total billed charges17.40.87999999999Percent of total billed charges14.420.721999999999Percent of total billed charges14.4218.2
INJECTION, SC/IM7022CDM260RCboth5739.948.450.85999999999 Percent of total billed charges51.870.91999999999 Percent of total billed charges44.460.78999999999Percent of total billed charges42.750.75999999999Percent of total billed charges49.590.87999999999Percent of total billed charges41.10.721999999999Percent of total billed charges41.151.87
D5W 250CC6024CDM260RCboth8861.674.80.85999999999 Percent of total billed charges80.080.91999999999 Percent of total billed charges68.640.78999999999Percent of total billed charges660.75999999999Percent of total billed charges76.560.87999999999Percent of total billed charges63.450.721999999999Percent of total billed charges63.4580.08
RL 500ML6048CDM260RCboth8861.674.80.85999999999 Percent of total billed charges80.080.91999999999 Percent of total billed charges68.640.78999999999Percent of total billed charges660.75999999999Percent of total billed charges76.560.87999999999Percent of total billed charges63.450.721999999999Percent of total billed charges63.4580.08
1/2NSS 1000CC6013CDM260RCboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges69.2287.36
D5 1/2 NS W/20MEQ KCL6053CDM260RCboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges69.2287.36
D5W 1/2NS 1000CC6008CDM260RCboth9667.281.60.85999999999 Percent of total billed charges87.360.91999999999 Percent of total billed charges74.880.78999999999Percent of total billed charges720.75999999999Percent of total billed charges83.520.87999999999Percent of total billed charges69.220.721999999999Percent of total billed charges69.2287.36
SPLINT, FINGER BASEBALL5124CDM270RCA4570CPTboth64.25.10.85999999999 Percent of total billed charges5.460.91999999999 Percent of total billed charges4.680.78999999999Percent of total billed charges6999999999Fee schedule4.50.75999999999Percent of total billed charges5.220.87999999999Percent of total billed charges4.330.721999999999Percent of total billed charges4.336
LEVINE TUBE5025CDM270RCB4083CPTboth42.83.40.85999999999 Percent of total billed charges3.640.91999999999 Percent of total billed charges3.120.78999999999Percent of total billed charges30.75999999999Percent of total billed charges3.480.87999999999Percent of total billed charges2.880.721999999999Percent of total billed charges2.883.64
STIFFNECK C. COLLAR5384CDM270RCL0140CPTboth0.01
SHOULDER IMMOBILIZERS5188CDM270RCL3670CPTboth0.01
SPLINT, WRIST5228CDM270RCL3809CPTboth210147178.50.85999999999 Percent of total billed charges191.10.91999999999 Percent of total billed charges163.80.78999999999Percent of total billed charges157.50.75999999999Percent of total billed charges182.70.87999999999Percent of total billed charges151.410.721999999999Percent of total billed charges151.41191.1
ARM SLING (LARGE)5385CDM270RCboth0.01
ARM SLING (MEDIUM)5386CDM270RCboth0.01
ARM SLING (SMALL)5387CDM270RCboth0.01
ARM SLING (X-LARGE)5002CDM270RCboth0.01
ARM SLING (X-SMALL)5388CDM270RCboth0.01
BRACE, AIRWALKER5498CDM270RCboth0.01
BRACE, ANKLE5401CDM270RCboth0.01
BRACE, KNEE5165CDM270RCboth0.01
BRACE, KNEE HINGED5164CDM270RCboth0.01
C. COLLAR (MEDIUM)5382CDM270RCboth0.01
C. COLLAR (SMALL)5383CDM270RCboth0.01
CERVICAL COLLAR HARD5082CDM270RCboth0.01
CRUTCHES5349CDM270RCboth0.01
DISP BAIR HUGGER BLKT ADULT5580CDM270RCboth0.01