,,,,,,,,Payer Allowed Amounts,,,,,,,,,,,,,,
Procedure,Code Type,Code,NDC,Rev Code,Procedure Description,Quantity,Gross Charge,Moda - Commercial,Providence,Cigna,Pacific Source - Inpatient,Pacific Source - Outpatient,Pacific Source Medicare,Blue Cross - Hospital,Multiplan,Aetna - Inpatient,Aetna - Outpatient,Aetna - ER,United Healthcare - Hospital,De-identified Minimum Rate,De-identified Maximum Rate,Discounted Cash Price if Paid within 45 days of service
12010001,EAP,Custom 12010001,,0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION,Hc R&b-semi-private,1,"2,890.00"," 2,745.50 ",2832.2," 2,745.50 "," 2,803.30 ",,Current Medicare Rates,2803.3,2774.4,Per Diem ($3150),N/A,N/A,2745.5,2745.5," 2,832.20 ",2601
12010011,EAP,Custom 12010001,,0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION,Hc R&b-semi-private Isolation,1,"5,245.00"," 4,982.75 ",5140.1," 4,982.75 "," 5,087.65 ",,Current Medicare Rates,5087.65,5035.2,Per Diem ($3150),N/A,N/A,4982.75,4982.75," 5,140.10 ",4720.5
12010009,EAP,Custom 12010009,,0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION,Hc R&b-semi-private Med Surg W/ Tele,1,"2,652.00"," 2,519.40 ",2598.96," 2,519.40 "," 2,572.44 ",,Current Medicare Rates,2572.44,2545.92,Per Diem ($3150),N/A,N/A,2519.4,2519.4," 2,598.96 ",2386.8
12010007,EAP,Custom 12010007,,0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION,Hc R&b-semi-private Respite,1,249, 236.55 ,244.02, 236.55 , 241.53 ,,Current Medicare Rates,241.53,239.04,Per Diem ($3150),N/A,N/A,236.55,236.55, 244.02 ,224.1
12010022,EAP,Custom 12010022,,0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION,Hc R&b-semi-private Respite Level 2,1,323, 306.85 ,316.54, 306.85 , 313.31 ,,Current Medicare Rates,313.31,310.08,Per Diem ($3150),N/A,N/A,306.85,306.85, 316.54 ,290.7
12010006,EAP,Custom 12010006,,0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION,Hc R&b-semi-private Respite Level 3,1,509, 483.55 ,498.82, 483.55 , 493.73 ,,Current Medicare Rates,493.73,488.64,Per Diem ($3150),N/A,N/A,483.55,483.55, 498.82 ,458.1
12010004,EAP,Custom 12010004,,0120 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION,Hc R&b-semi-private Swing Bed,1,"2,131.00"," 2,024.45 ",2088.38," 2,024.45 "," 2,067.07 ",,Current Medicare Rates,2067.07,2045.76,Per Diem ($3150),N/A,N/A,2024.45,2024.45," 2,088.38 ",1917.9
12210001,EAP,Custom 12210001,,0122 - ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - OB,Hc R&b-semi-private Ob,1,"2,867.00"," 2,723.65 ",2809.66," 2,723.65 "," 2,780.99 ",,Current Medicare Rates,2780.99,2752.32,Per Diem ($3150),N/A,N/A,2723.65,2723.65," 2,809.66 ",2580.3
17110001,EAP,Custom 17110001,,0171 - NURSERY - NEWBORN - LEVEL I,Hc R&b Nursery/level 1,1,"2,566.00"," 2,437.70 ",2514.68," 2,437.70 "," 2,489.02 ",,Current Medicare Rates,2489.02,2463.36,Per Diem ($1330),N/A,N/A,2437.7,2437.7," 2,514.68 ",2309.4
17210001,EAP,Custom 17210001,,0172 - NURSERY - NEWBORN - LEVEL II,Hc R&b Nursery/level 2,1,"4,118.00"," 3,912.10 ",4035.64," 3,912.10 "," 3,994.46 ",,Current Medicare Rates,3994.46,3953.28,Per Diem ($1330),N/A,N/A,3912.1,3912.1," 4,035.64 ",3706.2
17310001,EAP,Custom 17310001,,0173 - NURSERY - NEWBORN - LEVEL III,Hc R&b Nursery/level 3,1,"5,811.00"," 5,520.45 ",5694.78," 5,520.45 "," 5,636.67 ",,Current Medicare Rates,5636.67,5578.56,Per Diem ($1330),N/A,N/A,5520.45,5520.45," 5,694.78 ",5229.9
20610001,EAP,Custom 20610001,,0206 - INTENSIVE CARE - INTERMEDIATE ICU,Hc Intensive Care Intermediate,1,"5,652.00"," 5,369.40 ",5538.96," 5,369.40 "," 5,482.44 ",,Current Medicare Rates,5482.44,5425.92,Per Diem ($3350),N/A,N/A,5369.4,5369.4," 5,538.96 ",5086.8
20610002,EAP,Custom 20610002,,0206 - INTENSIVE CARE - INTERMEDIATE ICU,Hc Intensive Care Intermediate W/telemetry,1,"4,353.00"," 4,135.35 ",4265.94," 4,135.35 "," 4,222.41 ",,Current Medicare Rates,4222.41,4178.88,Per Diem ($3350),N/A,N/A,4135.35,4135.35," 4,265.94 ",3917.7
Rx35664001053,RX,,35664001053,0250 - PHARMACY -  GENERAL CLASSIFICATION,WOUND DRESSINGS - MISC,1,40.83, 38.79 ,40.01, 38.79 , 39.61 , 38.79 ,Current Medicare Rates,39.61,39.2,Included in per diem,38.79,Included in ER Case rate,38.79,38.79, 40.01 ,36.747
Rx00338080304,RX,,00338080304,0250 - PHARMACY -  GENERAL CLASSIFICATION,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.9% INJ,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00338067103,RX,,00338067103,0250 - PHARMACY -  GENERAL CLASSIFICATION,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ,1,54.74, 52.00 ,53.65, 52.00 , 53.10 , 52.00 ,Current Medicare Rates,53.1,52.55,Included in per diem,52,Included in ER Case rate,52,52, 53.65 ,49.266
Rx00338067104,RX,,00338067104,0250 - PHARMACY -  GENERAL CLASSIFICATION,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.45% INJ,1,93.98, 89.28 ,92.1, 89.28 , 91.16 , 89.28 ,Current Medicare Rates,91.16,90.22,Included in per diem,89.28,Included in ER Case rate,89.28,89.28, 92.10 ,84.582
Rx00338067504,RX,,00338067504,0250 - PHARMACY -  GENERAL CLASSIFICATION,KCL 40 MEQ/L (0.3%) IN DEXTROSE 5% & NACL 0.45% INJ,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00409317802,RX,,00409317802,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048227,RX,,63323048227,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048203,RX,,63323048203,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409317817,RX,,00409317817,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 1% W/ EPINEPHRINE-1:100000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048717,RX,,63323048717,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048701,RX,,63323048701,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 1% W/ EPINEPHRINE-1:200000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048327,RX,,63323048327,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048303,RX,,63323048303,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE INJ 2% W/ EPINEPHRINE-1:100000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx68180043501,RX,,68180043501,0250 - PHARMACY -  GENERAL CLASSIFICATION,GATIFLOXACIN OPHTH SOLN 0.5%,1,292.37, 277.75 ,286.52, 277.75 , 283.60 , 277.75 ,Current Medicare Rates,283.6,280.68,Included in per diem,277.75,Included in ER Case rate,277.75,277.75, 286.52 ,263.133
Rx50383018902,RX,,50383018902,0250 - PHARMACY -  GENERAL CLASSIFICATION,GATIFLOXACIN OPHTH SOLN 0.5%,1,248.27, 235.86 ,243.3, 235.86 , 240.82 , 235.86 ,Current Medicare Rates,240.82,238.34,Included in per diem,235.86,Included in ER Case rate,235.86,235.86, 243.30 ,223.443
Rx60758061525,RX,,60758061525,0250 - PHARMACY -  GENERAL CLASSIFICATION,GATIFLOXACIN OPHTH SOLN 0.5%,1,147.51, 140.13 ,144.56, 140.13 , 143.08 , 140.13 ,Current Medicare Rates,143.08,141.61,Included in per diem,140.13,Included in ER Case rate,140.13,140.13, 144.56 ,132.759
Rx00409337504,RX,,00409337504,0250 - PHARMACY -  GENERAL CLASSIFICATION,NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),1,24.41, 23.19 ,23.92, 23.19 , 23.68 , 23.19 ,Current Medicare Rates,23.68,23.43,Included in per diem,23.19,Included in ER Case rate,23.19,23.19, 23.92 ,21.969
Rx67457085200,RX,,67457085200,0250 - PHARMACY -  GENERAL CLASSIFICATION,NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),1,31.72, 30.13 ,31.09, 30.13 , 30.77 , 30.13 ,Current Medicare Rates,30.77,30.45,Included in per diem,30.13,Included in ER Case rate,30.13,30.13, 31.09 ,28.548
Rx67457085204,RX,,67457085204,0250 - PHARMACY -  GENERAL CLASSIFICATION,NOREPINEPHRINE BITARTRATE IV SOLN 1 MG/ML (BASE EQUIVALENT),1,31.62, 30.04 ,30.99, 30.04 , 30.67 , 30.04 ,Current Medicare Rates,30.67,30.36,Included in per diem,30.04,Included in ER Case rate,30.04,30.04, 30.99 ,28.458
Rx00409174910,RX,,00409174910,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000 (PF),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409155930,RX,,00409155930,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150016830,RX,,55150016830,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409155919,RX,,00409155919,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.25%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409156029,RX,,00409156029,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409116202,RX,,00409116202,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE HCL PRESERVATIVE FREE (PF) INJ 0.5%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx11704037001,RX,,11704037001,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROXOCOBALAMIN (ANTIDOTE) FOR IV SOLN 5 GM,1,1563.92," 1,485.72 ",1532.64," 1,485.72 "," 1,517.00 "," 1,485.72 ",Current Medicare Rates,1517,1501.36,Included in per diem,1485.72,Included in ER Case rate,1485.72,1485.72," 1,532.64 ",1407.528
Rx12870000101,RX,,12870000101,0250 - PHARMACY -  GENERAL CLASSIFICATION,SILVER NITRATE-POTASSIUM NITRATE APPLICATOR 75-25%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx63323064994,RX,,63323064994,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG,1,234.9, 223.16 ,230.2, 223.16 , 227.85 , 223.16 ,Current Medicare Rates,227.85,225.5,Included in per diem,223.16,Included in ER Case rate,223.16,223.16, 230.20 ,211.41
Rx42023020101,RX,,42023020101,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM FOR IV INJ 100 MCG,1,234.79, 223.05 ,230.09, 223.05 , 227.75 , 223.05 ,Current Medicare Rates,227.75,225.4,Included in per diem,223.05,Included in ER Case rate,223.05,223.05, 230.09 ,211.311
Rx00338004804,RX,,00338004804,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IRRIGATION SOLN 0.9%,1,93.98, 89.28 ,92.1, 89.28 , 91.16 , 89.28 ,Current Medicare Rates,91.16,90.22,Included in per diem,89.28,Included in ER Case rate,89.28,89.28, 92.10 ,84.582
Rx61553073503,RX,,61553073503,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYTOCIN-SODIUM CHLORIDE 0.9% IV SOLN 30 UNIT/500ML,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx54643564901,RX,,54643564901,0250 - PHARMACY -  GENERAL CLASSIFICATION,MULTIPLE VITAMIN INJ,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409116301,RX,,00409116301,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE HCL INJ 0.5%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409161050,RX,,00409161050,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE HCL INJ 0.5%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021067210,RX,,25021067210,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATRACURIUM BESYLATE IV SOLN 100 MG/10ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150021710,RX,,55150021710,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATRACURIUM BESYLATE IV SOLN 100 MG/10ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143968910,RX,,00143968910,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICARDIPINE HCL IV SOLN 2.5 MG/ML,1,67.06, 63.71 ,65.72, 63.71 , 65.05 , 63.71 ,Current Medicare Rates,65.05,64.38,Included in per diem,63.71,Included in ER Case rate,63.71,63.71, 65.72 ,60.354
Rx00143968901,RX,,00143968901,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICARDIPINE HCL IV SOLN 2.5 MG/ML,1,67.3, 63.94 ,65.95, 63.94 , 65.28 , 63.94 ,Current Medicare Rates,65.28,64.61,Included in per diem,63.94,Included in ER Case rate,63.94,63.94, 65.95 ,60.57
Rx00409163110,RX,,00409163110,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM CHLORIDE INJ 10%,1,28.59, 27.16 ,28.02, 27.16 , 27.73 , 27.16 ,Current Medicare Rates,27.73,27.45,Included in per diem,27.16,Included in ER Case rate,27.16,27.16, 28.02 ,25.731
Rx76329330401,RX,,76329330401,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM CHLORIDE INJ 10%,1,36.38, 34.56 ,35.65, 34.56 , 35.29 , 34.56 ,Current Medicare Rates,35.29,34.92,Included in per diem,34.56,Included in ER Case rate,34.56,34.56, 35.65 ,32.742
Rx16729023993,RX,,16729023993,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx16729023930,RX,,16729023930,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXMEDETOMIDINE HCL IV SOLN 200 MCG/2ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx70069013101,RX,,70069013101,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOBRAMYCIN OPHTH SOLN 0.3%,1,22.6, 21.47 ,22.15, 21.47 , 21.92 , 21.47 ,Current Medicare Rates,21.92,21.7,Included in per diem,21.47,Included in ER Case rate,21.47,21.47, 22.15 ,20.34
Rx17478029010,RX,,17478029010,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOBRAMYCIN OPHTH SOLN 0.3%,1,49.87, 47.38 ,48.87, 47.38 , 48.37 , 47.38 ,Current Medicare Rates,48.37,47.88,Included in per diem,47.38,Included in ER Case rate,47.38,47.38, 48.87 ,44.883
Rx24208029005,RX,,24208029005,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOBRAMYCIN OPHTH SOLN 0.3%,1,50.33, 47.81 ,49.32, 47.81 , 48.82 , 47.81 ,Current Medicare Rates,48.82,48.32,Included in per diem,47.81,Included in ER Case rate,47.81,47.81, 49.32 ,45.297
Rx61314064305,RX,,61314064305,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOBRAMYCIN OPHTH SOLN 0.3%,1,66.37, 63.05 ,65.04, 63.05 , 64.38 , 63.05 ,Current Medicare Rates,64.38,63.72,Included in per diem,63.05,Included in ER Case rate,63.05,63.05, 65.04 ,59.733
Rx00641602201,RX,,00641602201,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE INJ 20 MG/2ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323073911,RX,,63323073911,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE INJ 20 MG/2ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323073912,RX,,63323073912,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE INJ 20 MG/2ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409196607,RX,,00409196607,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409196602,RX,,00409196602,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACTERIOSTATIC SODIUM CHLORIDE INJ SOLN 0.9%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409729501,RX,,00409729501,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 66 MEQ/15ML (K),1,58.4, 55.48 ,57.23, 55.48 , 56.65 , 55.48 ,Current Medicare Rates,56.65,56.06,Included in per diem,55.48,Included in ER Case rate,55.48,55.48, 57.23 ,52.56
Rx42367054032,RX,,42367054032,0250 - PHARMACY -  GENERAL CLASSIFICATION,DANTROLENE SODIUM FOR IV SUSP 250 MG,1,2875.58," 2,731.80 ",2818.07," 2,731.80 "," 2,789.31 "," 2,731.80 ",Current Medicare Rates,2789.31,2760.56,Included in per diem,2731.8,Included in ER Case rate,2731.8,2731.8," 2,818.07 ",2588.022
Rx42023016401,RX,,42023016401,0250 - PHARMACY -  GENERAL CLASSIFICATION,VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION),1,176.37, 167.55 ,172.84, 167.55 , 171.08 , 167.55 ,Current Medicare Rates,171.08,169.32,Included in per diem,167.55,Included in ER Case rate,167.55,167.55, 172.84 ,158.733
Rx42023016425,RX,,42023016425,0250 - PHARMACY -  GENERAL CLASSIFICATION,VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION),1,176.3, 167.49 ,172.77, 167.49 , 171.01 , 167.49 ,Current Medicare Rates,171.01,169.25,Included in per diem,167.49,Included in ER Case rate,167.49,167.49, 172.77 ,158.67
Rx42023016410,RX,,42023016410,0250 - PHARMACY -  GENERAL CLASSIFICATION,VASOPRESSIN IV SOLN 20 UNIT/ML (FOR IV INFUSION),1,175.8, 167.01 ,172.28, 167.01 , 170.53 , 167.01 ,Current Medicare Rates,170.53,168.77,Included in per diem,167.01,Included in ER Case rate,167.01,167.01, 172.28 ,158.22
Rx53436008401,RX,,53436008401,0250 - PHARMACY -  GENERAL CLASSIFICATION,PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ),1,160.3, 152.29 ,157.09, 152.29 , 155.49 , 152.29 ,Current Medicare Rates,155.49,153.89,Included in per diem,152.29,Included in ER Case rate,152.29,152.29, 157.09 ,144.27
Rx53436008404,RX,,53436008404,0250 - PHARMACY -  GENERAL CLASSIFICATION,PATIROMER SORBITEX CALCIUM FOR SUSP PACKET 8.4 GM (BASE EQ),1,159.77, 151.78 ,156.57, 151.78 , 154.98 , 151.78 ,Current Medicare Rates,154.98,153.38,Included in per diem,151.78,Included in ER Case rate,151.78,151.78, 156.57 ,143.793
Rx00006542302,RX,,00006542302,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT),1,341.11, 324.05 ,334.29, 324.05 , 330.88 , 324.05 ,Current Medicare Rates,330.88,327.47,Included in per diem,324.05,Included in ER Case rate,324.05,324.05, 334.29 ,306.999
Rx00006542312,RX,,00006542312,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUGAMMADEX SODIUM IV 200 MG/2ML (BASE EQUIVALENT),1,340, 323.00 ,333.2, 323.00 , 329.80 , 323.00 ,Current Medicare Rates,329.8,326.4,Included in per diem,323,Included in ER Case rate,323,323, 333.20 ,306
Rx00338104902,RX,,00338104902,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN IV SOLN 200 MCG/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00517096010,RX,,00517096010,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),1,60.68, 57.65 ,59.47, 57.65 , 58.86 , 57.65 ,Current Medicare Rates,58.86,58.25,Included in per diem,57.65,Included in ER Case rate,57.65,57.65, 59.47 ,54.612
Rx00517096001,RX,,00517096001,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),1,195.38, 185.61 ,191.47, 185.61 , 189.52 , 185.61 ,Current Medicare Rates,189.52,187.56,Included in per diem,185.61,Included in ER Case rate,185.61,185.61, 191.47 ,175.842
Rx23155052431,RX,,23155052431,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),1,192.5, 182.88 ,188.65, 182.88 , 186.73 , 182.88 ,Current Medicare Rates,186.73,184.8,Included in per diem,182.88,Included in ER Case rate,182.88,182.88, 188.65 ,173.25
Rx23155052441,RX,,23155052441,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),1,192.5, 182.88 ,188.65, 182.88 , 186.73 , 182.88 ,Current Medicare Rates,186.73,184.8,Included in per diem,182.88,Included in ER Case rate,182.88,182.88, 188.65 ,173.25
Rx61990061100,RX,,61990061100,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),1,46.49, 44.17 ,45.56, 44.17 , 45.10 , 44.17 ,Current Medicare Rates,45.1,44.63,Included in per diem,44.17,Included in ER Case rate,44.17,44.17, 45.56 ,41.841
Rx61990061102,RX,,61990061102,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRANEXAMIC ACID IV SOLN 1000 MG/10ML (100 MG/ML),1,46.43, 44.11 ,45.5, 44.11 , 45.04 , 44.11 ,Current Medicare Rates,45.04,44.57,Included in per diem,44.11,Included in ER Case rate,44.11,44.11, 45.50 ,41.787
Rx00527172874,RX,,00527172874,0250 - PHARMACY -  GENERAL CLASSIFICATION,COCAINE HCL SOLN 4%,1,561.68, 533.60 ,550.45, 533.60 , 544.83 , 533.60 ,Current Medicare Rates,544.83,539.21,Included in per diem,533.6,Included in ER Case rate,533.6,533.6, 550.45 ,505.512
Rx00409488820,RX,,00409488820,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409488810,RX,,00409488810,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409488802,RX,,00409488802,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409488803,RX,,00409488803,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323018620,RX,,63323018620,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE PRESERVATIVE FREE (PF) INJ 0.9%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00187430202,RX,,00187430202,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,1,930.83, 884.29 ,912.21, 884.29 , 902.91 , 884.29 ,Current Medicare Rates,902.91,893.6,Included in per diem,884.29,Included in ER Case rate,884.29,884.29, 912.21 ,837.747
Rx14789001202,RX,,14789001202,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,1,233.13, 221.47 ,228.47, 221.47 , 226.14 , 221.47 ,Current Medicare Rates,226.14,223.8,Included in per diem,221.47,Included in ER Case rate,221.47,221.47, 228.47 ,209.817
Rx67457083902,RX,,67457083902,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,1,90.39, 85.87 ,88.58, 85.87 , 87.68 , 85.87 ,Current Medicare Rates,87.68,86.77,Included in per diem,85.87,Included in ER Case rate,85.87,85.87, 88.58 ,81.351
Rx70069026101,RX,,70069026101,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROPRUSSIDE SODIUM IV SOLN 25 MG/ML,1,64, 60.80 ,62.72, 60.80 , 62.08 , 60.80 ,Current Medicare Rates,62.08,61.44,Included in per diem,60.8,Included in ER Case rate,60.8,60.8, 62.72 ,57.6
Rx00338051909,RX,,00338051909,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAT EMULSION PLANT BASED (SOY) IV EMULSION 20%,1,123.66, 117.48 ,121.19, 117.48 , 119.95 , 117.48 ,Current Medicare Rates,119.95,118.71,Included in per diem,117.48,Included in ER Case rate,117.48,117.48, 121.19 ,111.294
Rx60267070550,RX,,60267070550,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM THIOSULFATE IV SOLN 250 MG/ML (25%),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00283061026,RX,,00283061026,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZOCAINE DENTAL SOLN 20%,1,43.37, 41.20 ,42.5, 41.20 , 42.07 , 41.20 ,Current Medicare Rates,42.07,41.64,Included in per diem,41.2,Included in ER Case rate,41.2,41.2, 42.50 ,39.033
Rx17478071310,RX,,17478071310,0250 - PHARMACY -  GENERAL CLASSIFICATION,OFLOXACIN OPHTH SOLN 0.3%,1,42.17, 40.06 ,41.33, 40.06 , 40.90 , 40.06 ,Current Medicare Rates,40.9,40.48,Included in per diem,40.06,Included in ER Case rate,40.06,40.06, 41.33 ,37.953
Rx64980051501,RX,,64980051501,0250 - PHARMACY -  GENERAL CLASSIFICATION,OFLOXACIN OPHTH SOLN 0.3%,1,79.07, 75.12 ,77.49, 75.12 , 76.70 , 75.12 ,Current Medicare Rates,76.7,75.91,Included in per diem,75.12,Included in ER Case rate,75.12,75.12, 77.49 ,71.163
Rx17478010002,RX,,17478010002,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOPENTOLATE HCL OPHTH SOLN 1%,1,19.03, 18.08 ,18.65, 18.08 , 18.46 , 18.08 ,Current Medicare Rates,18.46,18.27,Included in per diem,18.08,Included in ER Case rate,18.08,18.08, 18.65 ,17.127
Rx24208073501,RX,,24208073501,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOPENTOLATE HCL OPHTH SOLN 1%,1,51.81, 49.22 ,50.77, 49.22 , 50.26 , 49.22 ,Current Medicare Rates,50.26,49.74,Included in per diem,49.22,Included in ER Case rate,49.22,49.22, 50.77 ,46.629
Rx00065039602,RX,,00065039602,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOPENTOLATE HCL OPHTH SOLN 1%,1,104.85, 99.61 ,102.75, 99.61 , 101.70 , 99.61 ,Current Medicare Rates,101.7,100.66,Included in per diem,99.61,Included in ER Case rate,99.61,99.61, 102.75 ,94.365
Rx61314039601,RX,,61314039601,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOPENTOLATE HCL OPHTH SOLN 1%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00409669502,RX,,00409669502,0250 - PHARMACY -  GENERAL CLASSIFICATION,ETOMIDATE IV SOLN 2 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143950701,RX,,00143950701,0250 - PHARMACY -  GENERAL CLASSIFICATION,ETOMIDATE IV SOLN 2 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143950710,RX,,00143950710,0250 - PHARMACY -  GENERAL CLASSIFICATION,ETOMIDATE IV SOLN 2 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150022220,RX,,55150022220,0250 - PHARMACY -  GENERAL CLASSIFICATION,ETOMIDATE IV SOLN 2 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049416,RX,,63323049416,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALPROATE SODIUM INJ 100 MG/ML,1,28.76, 27.32 ,28.18, 27.32 , 27.90 , 27.32 ,Current Medicare Rates,27.9,27.61,Included in per diem,27.32,Included in ER Case rate,27.32,27.32, 28.18 ,25.884
Rx63323049401,RX,,63323049401,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALPROATE SODIUM INJ 100 MG/ML,1,28.78, 27.34 ,28.2, 27.34 , 27.92 , 27.34 ,Current Medicare Rates,27.92,27.63,Included in per diem,27.34,Included in ER Case rate,27.34,27.34, 28.20 ,25.902
Rx63323049405,RX,,63323049405,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALPROATE SODIUM INJ 100 MG/ML,1,28.69, 27.26 ,28.12, 27.26 , 27.83 , 27.26 ,Current Medicare Rates,27.83,27.54,Included in per diem,27.26,Included in ER Case rate,27.26,27.26, 28.12 ,25.821
Rx00338111504,RX,,00338111504,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMINO ACID ELECTROLYTE W/CAL INFUSION 4.25% IN D10W,1,238.96, 227.01 ,234.18, 227.01 , 231.79 , 227.01 ,Current Medicare Rates,231.79,229.4,Included in per diem,227.01,Included in ER Case rate,227.01,227.01, 234.18 ,215.064
Rx00338112304,RX,,00338112304,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D15W,1,260.59, 247.56 ,255.38, 247.56 , 252.77 , 247.56 ,Current Medicare Rates,252.77,250.17,Included in per diem,247.56,Included in ER Case rate,247.56,247.56, 255.38 ,234.531
Rx00338112704,RX,,00338112704,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D25W,1,267.8, 254.41 ,262.44, 254.41 , 259.77 , 254.41 ,Current Medicare Rates,259.77,257.09,Included in per diem,254.41,Included in ER Case rate,254.41,254.41, 262.44 ,241.02
Rx00338114903,RX,,00338114903,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMINO ACID ELECTROLYTE W/CAL INFUSION 5% IN D25W,1,243.75, 231.56 ,238.88, 231.56 , 236.44 , 231.56 ,Current Medicare Rates,236.44,234,Included in per diem,231.56,Included in ER Case rate,231.56,231.56, 238.88 ,219.375
Rx00409664802,RX,,00409664802,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 50%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx76329330101,RX,,76329330101,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 50%,1,49.36, 46.89 ,48.37, 46.89 , 47.88 , 46.89 ,Current Medicare Rates,47.88,47.39,Included in per diem,46.89,Included in ER Case rate,46.89,46.89, 48.37 ,44.424
Rx43292055812,RX,,43292055812,0250 - PHARMACY -  GENERAL CLASSIFICATION,CRANBERRY (VACCINIUM MACROCARPON) CAP 425 MG,1,5.84, 5.55 ,5.72, 5.55 , 5.66 , 5.55 ,Current Medicare Rates,5.66,5.61,Included in per diem,5.55,Included in ER Case rate,5.55,5.55, 5.72 ,5.256
Rx00264196510,RX,,00264196510,0250 - PHARMACY -  GENERAL CLASSIFICATION,HETASTARCH IN SODIUM CHLORIDE INJ 6-0.9%,1,66.69, 63.36 ,65.36, 63.36 , 64.69 , 63.36 ,Current Medicare Rates,64.69,64.02,Included in per diem,63.36,Included in ER Case rate,63.36,63.36, 65.36 ,60.021
Rx00409724813,RX,,00409724813,0250 - PHARMACY -  GENERAL CLASSIFICATION,HETASTARCH IN SODIUM CHLORIDE INJ 6-0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338109504,RX,,00338109504,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMINO ACID INFUSION 4.25% IN D25W,1,231.75, 220.16 ,227.12, 220.16 , 224.80 , 220.16 ,Current Medicare Rates,224.8,222.48,Included in per diem,220.16,Included in ER Case rate,220.16,220.16, 227.12 ,208.575
Rx00338108904,RX,,00338108904,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMINO ACID INFUSION 4.25% IN D5W,1,224.54, 213.31 ,220.05, 213.31 , 217.80 , 213.31 ,Current Medicare Rates,217.8,215.56,Included in per diem,213.31,Included in ER Case rate,213.31,213.31, 220.05 ,202.086
Rx00338113303,RX,,00338113303,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMINO ACID INFUSION 4.25% IN D5W,1,166.86, 158.52 ,163.52, 158.52 , 161.85 , 158.52 ,Current Medicare Rates,161.85,160.19,Included in per diem,158.52,Included in ER Case rate,158.52,158.52, 163.52 ,150.174
Rx63323013011,RX,,63323013011,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE FOR INJ 100 MG,1,70.61, 67.08 ,69.2, 67.08 , 68.49 , 67.08 ,Current Medicare Rates,68.49,67.79,Included in per diem,67.08,Included in ER Case rate,67.08,67.08, 69.20 ,63.549
Rx67457043700,RX,,67457043700,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE FOR INJ 100 MG,1,71.62, 68.04 ,70.19, 68.04 , 69.47 , 68.04 ,Current Medicare Rates,69.47,68.76,Included in per diem,68.04,Included in ER Case rate,68.04,68.04, 70.19 ,64.458
Rx67457043710,RX,,67457043710,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE FOR INJ 100 MG,1,71.38, 67.81 ,69.95, 67.81 , 69.24 , 67.81 ,Current Medicare Rates,69.24,68.52,Included in per diem,67.81,Included in ER Case rate,67.81,67.81, 69.95 ,64.242
Rx68382091001,RX,,68382091001,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE FOR INJ 100 MG,1,88.44, 84.02 ,86.67, 84.02 , 85.79 , 84.02 ,Current Medicare Rates,85.79,84.9,Included in per diem,84.02,Included in ER Case rate,84.02,84.02, 86.67 ,79.596
Rx68382091010,RX,,68382091010,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE FOR INJ 100 MG,1,91.96, 87.36 ,90.12, 87.36 , 89.20 , 87.36 ,Current Medicare Rates,89.2,88.28,Included in per diem,87.36,Included in ER Case rate,87.36,87.36, 90.12 ,82.764
Rx55566280001,RX,,55566280001,0250 - PHARMACY -  GENERAL CLASSIFICATION,DINOPROSTONE VAGINAL INSERTS 10 MG,1,652.31, 619.69 ,639.26, 619.69 , 632.74 , 619.69 ,Current Medicare Rates,632.74,626.22,Included in per diem,619.69,Included in ER Case rate,619.69,619.69, 639.26 ,587.079
Rx17238090011,RX,,17238090011,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUORESCEIN SODIUM OPHTH STRIPS 1 MG,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx14789001401,RX,,14789001401,0250 - PHARMACY -  GENERAL CLASSIFICATION,EPHEDRINE SULFATE INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx61314014405,RX,,61314014405,0250 - PHARMACY -  GENERAL CLASSIFICATION,BRIMONIDINE TARTRATE OPHTH SOLN 0.15%,1,429.41, 407.94 ,420.82, 407.94 , 416.53 , 407.94 ,Current Medicare Rates,416.53,412.23,Included in per diem,407.94,Included in ER Case rate,407.94,407.94, 420.82 ,386.469
Rx39822110001,RX,,39822110001,0250 - PHARMACY -  GENERAL CLASSIFICATION,FOLIC ACID INJ 5 MG/ML,1,206, 195.70 ,201.88, 195.70 , 199.82 , 195.70 ,Current Medicare Rates,199.82,197.76,Included in per diem,195.7,Included in ER Case rate,195.7,195.7, 201.88 ,185.4
Rx63323018410,RX,,63323018410,0250 - PHARMACY -  GENERAL CLASSIFICATION,FOLIC ACID INJ 5 MG/ML,1,206, 195.70 ,201.88, 195.70 , 199.82 , 195.70 ,Current Medicare Rates,199.82,197.76,Included in per diem,195.7,Included in ER Case rate,195.7,195.7, 201.88 ,185.4
Rx00517460125,RX,,00517460125,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYCOPYRROLATE INJ 0.2 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323057801,RX,,63323057801,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYCOPYRROLATE INJ 0.2 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323057803,RX,,63323057803,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYCOPYRROLATE INJ 0.2 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781713593,RX,,00781713593,0250 - PHARMACY -  GENERAL CLASSIFICATION,MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV),1,109.67, 104.19 ,107.48, 104.19 , 106.38 , 104.19 ,Current Medicare Rates,106.38,105.28,Included in per diem,104.19,Included in ER Case rate,104.19,104.19, 107.48 ,98.703
Rx00065401303,RX,,00065401303,0250 - PHARMACY -  GENERAL CLASSIFICATION,MOXIFLOXACIN HCL OPHTH SOLN 0.5% (BASE EQUIV),1,537.57, 510.69 ,526.82, 510.69 , 521.44 , 510.69 ,Current Medicare Rates,521.44,516.07,Included in per diem,510.69,Included in ER Case rate,510.69,510.69, 526.82 ,483.813
Rx49348099136,RX,,49348099136,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENOL LIQUID 1.4%,1,23.38, 22.21 ,22.91, 22.21 , 22.68 , 22.21 ,Current Medicare Rates,22.68,22.44,Included in per diem,22.21,Included in ER Case rate,22.21,22.21, 22.91 ,21.042
Rx00781315972,RX,,00781315972,0250 - PHARMACY -  GENERAL CLASSIFICATION,OLANZAPINE FOR IM INJ 10 MG,1,74.57, 70.84 ,73.08, 70.84 , 72.33 , 70.84 ,Current Medicare Rates,72.33,71.59,Included in per diem,70.84,Included in ER Case rate,70.84,70.84, 73.08 ,67.113
Rx63323042405,RX,,63323042405,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143978401,RX,,00143978401,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUMAZENIL IV SOLN 0.5 MG/5ML (0.1 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx66794001710,RX,,66794001710,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOFLURANE INHAL SOLN,1,59.79, 56.80 ,58.59, 56.80 , 58.00 , 56.80 ,Current Medicare Rates,58,57.4,Included in per diem,56.8,Included in ER Case rate,56.8,56.8, 58.59 ,53.811
Rx00409781124,RX,,00409781124,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METRONIDAZOLE IN NACL 0.79% IV SOLN 500 MG/100ML,METRONIDAZOLE IN NACL 0.74% IV SOLN 500 MG/100ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00000000308,RX,,00000000308,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFOTETAN 100 MG/ML IV SYRINGE,1,35.96, 34.16 ,35.24, 34.16 , 34.88 , 34.16 ,Current Medicare Rates,34.88,34.52,Included in per diem,34.16,Included in ER Case rate,34.16,34.16, 35.24 ,32.364
Rx76329301505,RX,,76329301505,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%",1,34.39, 32.67 ,33.7, 32.67 , 33.36 , 32.67 ,Current Medicare Rates,33.36,33.01,Included in per diem,32.67,Included in ER Case rate,32.67,32.67, 33.70 ,30.951
Rx00000001875,RX,,00000001875,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE 0.125% INJECTION (ANESTHESIA MIX),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00338013727,RX,,00338013727,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTATED RINGER'S FOR IRRIGATION,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx76329630005,RX,,76329630005,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%,1,27.64, 26.26 ,27.09, 26.26 , 26.81 , 26.26 ,Current Medicare Rates,26.81,26.53,Included in per diem,26.26,Included in ER Case rate,26.26,26.26, 27.09 ,24.876
Rx00264757810,RX,,00264757810,0250 - PHARMACY -  GENERAL CLASSIFICATION,MANNITOL IV SOLN 20%,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00338035703,RX,,00338035703,0250 - PHARMACY -  GENERAL CLASSIFICATION,MANNITOL IV SOLN 20%,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx63323032710,RX,,63323032710,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAFCILLIN SODIUM FOR INJ 1 GM,1,64.54, 61.31 ,63.25, 61.31 , 62.60 , 61.31 ,Current Medicare Rates,62.6,61.96,Included in per diem,61.31,Included in ER Case rate,61.31,61.31, 63.25 ,58.086
Rx25021013910,RX,,25021013910,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAFCILLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx70860011626,RX,,70860011626,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAFCILLIN SODIUM FOR INJ 1 GM,1,48.43, 46.01 ,47.46, 46.01 , 46.98 , 46.01 ,Current Medicare Rates,46.98,46.49,Included in per diem,46.01,Included in ER Case rate,46.01,46.01, 47.46 ,43.587
Rx70860011641,RX,,70860011641,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAFCILLIN SODIUM FOR INJ 1 GM,1,48.43, 46.01 ,47.46, 46.01 , 46.98 , 46.01 ,Current Medicare Rates,46.98,46.49,Included in per diem,46.01,Included in ER Case rate,46.01,46.01, 47.46 ,43.587
Rx63323032820,RX,,63323032820,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAFCILLIN SODIUM FOR INJ 2 GM,1,109.92, 104.42 ,107.72, 104.42 , 106.62 , 104.42 ,Current Medicare Rates,106.62,105.52,Included in per diem,104.42,Included in ER Case rate,104.42,104.42, 107.72 ,98.928
Rx63323032821,RX,,63323032821,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAFCILLIN SODIUM FOR INJ 2 GM,1,110.28, 104.77 ,108.07, 104.77 , 106.97 , 104.77 ,Current Medicare Rates,106.97,105.87,Included in per diem,104.77,Included in ER Case rate,104.77,104.77, 108.07 ,99.252
Rx00904660161,RX,,00904660161,0250 - PHARMACY -  GENERAL CLASSIFICATION,PERPHENAZINE TAB 8 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42702010215,RX,,42702010215,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYLEPHRINE HCL OPHTH SOLN 2.5%,1,278.32, 264.40 ,272.75, 264.40 , 269.97 , 264.40 ,Current Medicare Rates,269.97,267.19,Included in per diem,264.4,Included in ER Case rate,264.4,264.4, 272.75 ,250.488
Rx17478051002,RX,,17478051002,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHYSOSTIGMINE SALICYLATE INJ 1 MG/ML,1,83.81, 79.62 ,82.13, 79.62 , 81.30 , 79.62 ,Current Medicare Rates,81.3,80.46,Included in per diem,79.62,Included in ER Case rate,79.62,79.62, 82.13 ,75.429
Rx61314020315,RX,,61314020315,0250 - PHARMACY -  GENERAL CLASSIFICATION,PILOCARPINE HCL OPHTH SOLN 1%,1,186.39, 177.07 ,182.66, 177.07 , 180.80 , 177.07 ,Current Medicare Rates,180.8,178.93,Included in per diem,177.07,Included in ER Case rate,177.07,177.07, 182.66 ,167.751
Rx61314020415,RX,,61314020415,0250 - PHARMACY -  GENERAL CLASSIFICATION,PILOCARPINE HCL OPHTH SOLN 2%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx61314063710,RX,,61314063710,0250 - PHARMACY -  GENERAL CLASSIFICATION,PREDNISOLONE ACETATE OPHTH SUSP 1%,1,155.73, 147.94 ,152.62, 147.94 , 151.06 , 147.94 ,Current Medicare Rates,151.06,149.5,Included in per diem,147.94,Included in ER Case rate,147.94,147.94, 152.62 ,140.157
Rx67457011850,RX,,67457011850,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASCORBIC ACID INJ 500 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx17478026312,RX,,17478026312,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROPARACAINE HCL OPHTH SOLN 0.5%,1,132.25, 125.64 ,129.61, 125.64 , 128.28 , 125.64 ,Current Medicare Rates,128.28,126.96,Included in per diem,125.64,Included in ER Case rate,125.64,125.64, 129.61 ,119.025
Rx24208073006,RX,,24208073006,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROPARACAINE HCL OPHTH SOLN 0.5%,1,133.54, 126.86 ,130.87, 126.86 , 129.53 , 126.86 ,Current Medicare Rates,129.53,128.2,Included in per diem,126.86,Included in ER Case rate,126.86,126.86, 130.87 ,120.186
Rx61314001601,RX,,61314001601,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROPARACAINE HCL OPHTH SOLN 0.5%,1,83.49, 79.32 ,81.82, 79.32 , 80.99 , 79.32 ,Current Medicare Rates,80.99,80.15,Included in per diem,79.32,Included in ER Case rate,79.32,79.32, 81.82 ,75.141
Rx00409729973,RX,,00409729973,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM ACETATE INJ 2 MEQ/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409553434,RX,,00409553434,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE IV SOLN 4.2%,1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx63323002605,RX,,63323002605,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE IV SOLN 4.2%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409662502,RX,,00409662502,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE IV SOLN 8.4%,1,19.44, 18.47 ,19.05, 18.47 , 18.86 , 18.47 ,Current Medicare Rates,18.86,18.66,Included in per diem,18.47,Included in ER Case rate,18.47,18.47, 19.05 ,17.496
Rx76329335201,RX,,76329335201,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE IV SOLN 8.4%,1,49.82, 47.33 ,48.82, 47.33 , 48.33 , 47.33 ,Current Medicare Rates,48.33,47.83,Included in per diem,47.33,Included in ER Case rate,47.33,47.33, 48.82 ,44.838
Rx63323008950,RX,,63323008950,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE IV SOLN 8.4%,1,46.69, 44.36 ,45.76, 44.36 , 45.29 , 44.36 ,Current Medicare Rates,45.29,44.82,Included in per diem,44.36,Included in ER Case rate,44.36,44.36, 45.76 ,42.021
Rx00338004303,RX,,00338004303,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338004304,RX,,00338004304,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,93.98, 89.28 ,92.1, 89.28 , 91.16 , 89.28 ,Current Medicare Rates,91.16,90.22,Included in per diem,89.28,Included in ER Case rate,89.28,89.28, 92.10 ,84.582
Rx63323009301,RX,,63323009301,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%),1,25.02, 23.77 ,24.52, 23.77 , 24.27 , 23.77 ,Current Medicare Rates,24.27,24.02,Included in per diem,23.77,Included in ER Case rate,23.77,23.77, 24.52 ,22.518
Rx63323009330,RX,,63323009330,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%),1,25.02, 23.77 ,24.52, 23.77 , 24.27 , 23.77 ,Current Medicare Rates,24.27,24.02,Included in per diem,23.77,Included in ER Case rate,23.77,23.77, 24.52 ,22.518
Rx63323018730,RX,,63323018730,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 4 MEQ/ML (23.4%),1,20.25, 19.24 ,19.85, 19.24 , 19.64 , 19.24 ,Current Medicare Rates,19.64,19.44,Included in per diem,19.24,Included in ER Case rate,19.24,19.24, 19.85 ,18.225
Rx00487930133,RX,,00487930133,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE SOLN NEBU 0.9%,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00487930103,RX,,00487930103,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE SOLN NEBU 0.9%,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00378699889,RX,,00378699889,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE SOLN NEBU 10%,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00409798509,RX,,00409798509,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00409798502,RX,,00409798502,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,100.74, 95.70 ,98.73, 95.70 , 97.72 , 95.70 ,Current Medicare Rates,97.72,96.71,Included in per diem,95.7,Included in ER Case rate,95.7,95.7, 98.73 ,90.666
Rx00409798503,RX,,00409798503,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409713266,RX,,00409713266,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409773020,RX,,00409773020,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,82.65, 78.52 ,81, 78.52 , 80.17 , 78.52 ,Current Medicare Rates,80.17,79.34,Included in per diem,78.52,Included in ER Case rate,78.52,78.52, 81.00 ,74.385
Rx00409773036,RX,,00409773036,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409773037,RX,,00409773037,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,98.81, 93.87 ,96.83, 93.87 , 95.85 , 93.87 ,Current Medicare Rates,95.85,94.86,Included in per diem,93.87,Included in ER Case rate,93.87,93.87, 96.83 ,88.929
Rx00409713267,RX,,00409713267,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,94.95, 90.20 ,93.05, 90.20 , 92.10 , 90.20 ,Current Medicare Rates,92.1,91.15,Included in per diem,90.2,Included in ER Case rate,90.2,90.2, 93.05 ,85.455
Rx00409713202,RX,,00409713202,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,93.98, 89.28 ,92.1, 89.28 , 91.16 , 89.28 ,Current Medicare Rates,91.16,90.22,Included in per diem,89.28,Included in ER Case rate,89.28,89.28, 92.10 ,84.582
Rx00264780200,RX,,00264780200,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00264780210,RX,,00264780210,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338004304,RX,,00338004304,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409798525,RX,,00409798525,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409713204,RX,,00409713204,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409713268,RX,,00409713268,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409713269,RX,,00409713269,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.45%,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx62295501303,RX,,62295501303,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LIDOCAINE-EPINEPHRINE-TETRACAINE GEL 4-0.05-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.18-0.5%",1,20.54, 19.51 ,20.13, 19.51 , 19.92 , 19.51 ,Current Medicare Rates,19.92,19.72,Included in per diem,19.51,Included in ER Case rate,19.51,19.51, 20.13 ,18.486
Rx71266629001,RX,,71266629001,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LIDOCAINE-EPINEPHRINE-TETRACAINE GEL 4-0.05-0.5%,LIDOCAINE HCL-EPINEPHRINE BIT-TETRACAINE HCL GEL 4-0.18-0.5%",1,16.12, 15.31 ,15.8, 15.31 , 15.64 , 15.31 ,Current Medicare Rates,15.64,15.48,Included in per diem,15.31,Included in ER Case rate,15.31,15.31, 15.80 ,14.508
Rx00409796709,RX,,00409796709,0250 - PHARMACY -  GENERAL CLASSIFICATION,"ELECTROLYTE-R SOLUTION,ELECTROLYTE-148 SOLUTION,ELECTROLYTE-R (PH 7.4) SOLUTION,ELECTROLYTE-A SOLUTION",1,24.46, 23.24 ,23.97, 23.24 , 23.73 , 23.24 ,Current Medicare Rates,23.73,23.48,Included in per diem,23.24,Included in ER Case rate,23.24,23.24, 23.97 ,22.014
Rx00338066304,RX,,00338066304,0250 - PHARMACY -  GENERAL CLASSIFICATION,"KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.2% INJ,KCL 20 MEQ/L (0.15%) IN DEXTROSE 5% & NACL 0.225% INJ",1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00338007704,RX,,00338007704,0250 - PHARMACY -  GENERAL CLASSIFICATION,"DEXTROSE 5% W/ SODIUM CHLORIDE 0.2%,DEXTROSE 5% W/ SODIUM CHLORIDE 0.225%",1,93.98, 89.28 ,92.1, 89.28 , 91.16 , 89.28 ,Current Medicare Rates,91.16,90.22,Included in per diem,89.28,Included in ER Case rate,89.28,89.28, 92.10 ,84.582
Rx00409177835,RX,,00409177835,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323066005,RX,,63323066005,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx36000003310,RX,,36000003310,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143966001,RX,,00143966001,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx70860030005,RX,,70860030005,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx47781058717,RX,,47781058717,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx47781058720,RX,,47781058720,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx70860030041,RX,,70860030041,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METOPROLOL TARTRATE IV SOLN 5 MG/5ML,METOPROLOL TARTRATE IV SOLN CART INJ 5 MG/5ML (1 MG/ML),METOPROLOL TARTRATE IV SOLN PREFILLED SYR 5 MG/5ML",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323017005,RX,,63323017005,0250 - PHARMACY -  GENERAL CLASSIFICATION,"SODIUM PHOSPHATES INJ 15 MM/5ML (PHOS) 20 MEQ/5ML (NA),SODIUM PHOSPHATES INJ 45 MM/15ML (PHOS) 60 MEQ/15ML (NA),SODIUM PHOSPHATES INJ 150 MM/50ML (PHOS) 200 MEQ/50ML (NA)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00409233934,RX,,00409233934,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409226720,RX,,00409226720,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143962201,RX,,00143962201,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx47781058629,RX,,47781058629,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409233924,RX,,00409233924,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LABETALOL HCL IV SOLN 5 MG/ML,LABETALOL HCL IV SOLN PREFILLED SYRINGE 20 MG/4ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 50 MG/10ML (5 MG/ML),LABETALOL HCL IV SOLN PREFILLED SYRINGE 25 MG/5ML (5 MG/ML)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457022800,RX,,67457022800,0250 - PHARMACY -  GENERAL CLASSIFICATION,"ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 50 MG/5ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 100 MG/10ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYRINGE 20 MG/2ML (10 MG/ML),ROCURONIUM BROMIDE IV SOLN PREF SYR 75 MG/7.5ML (10 MG/ML)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00409781124,RX,,00409781124,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METRONIDAZOLE IN NACL 0.79% IV SOLN 500 MG/100ML,METRONIDAZOLE IN NACL 0.74% IV SOLN 500 MG/100ML",1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00338105548,RX,,00338105548,0250 - PHARMACY -  GENERAL CLASSIFICATION,"METRONIDAZOLE IN NACL 0.79% IV SOLN 500 MG/100ML,METRONIDAZOLE IN NACL 0.74% IV SOLN 500 MG/100ML",1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00409488720,RX,,00409488720,0250 - PHARMACY -  GENERAL CLASSIFICATION,WATER FOR INJECTION,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409488710,RX,,00409488710,0250 - PHARMACY -  GENERAL CLASSIFICATION,WATER FOR INJECTION,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409488717,RX,,00409488717,0250 - PHARMACY -  GENERAL CLASSIFICATION,WATER FOR INJECTION,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323018510,RX,,63323018510,0250 - PHARMACY -  GENERAL CLASSIFICATION,WATER FOR INJECTION,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00703952601,RX,,00703952601,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM IV SOLN 400-80 MG/5ML,1,102.34, 97.22 ,100.29, 97.22 , 99.27 , 97.22 ,Current Medicare Rates,99.27,98.25,Included in per diem,97.22,Included in ER Case rate,97.22,97.22, 100.29 ,92.106
Rx00006496301,RX,,00006496301,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZOSTER VACCINE LIVE FOR SUBCUTANEOUS SUSP 19400 UNIT/0.65ML,1,743.14, 705.98 ,728.28, 705.98 , 720.85 , 705.98 ,Current Medicare Rates,720.85,713.41,Included in per diem,705.98,Included in ER Case rate,705.98,705.98, 728.28 ,668.826
Rx00065074114,RX,,00065074114,0250 - PHARMACY -  GENERAL CLASSIFICATION,TETRACAINE HCL OPHTH SOLN 0.5%,1,45.34, 43.07 ,44.43, 43.07 , 43.98 , 43.07 ,Current Medicare Rates,43.98,43.53,Included in per diem,43.07,Included in ER Case rate,43.07,43.07, 44.43 ,40.806
Rx24208092064,RX,,24208092064,0250 - PHARMACY -  GENERAL CLASSIFICATION,TETRACAINE HCL OPHTH SOLN 0.5%,1,28.85, 27.41 ,28.27, 27.41 , 27.98 , 27.41 ,Current Medicare Rates,27.98,27.7,Included in per diem,27.41,Included in ER Case rate,27.41,27.41, 28.27 ,25.965
Rx63323065210,RX,,63323065210,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESMOLOL HCL INJ 100 MG/10ML,1,61.55, 58.47 ,60.32, 58.47 , 59.70 , 58.47 ,Current Medicare Rates,59.7,59.09,Included in per diem,58.47,Included in ER Case rate,58.47,58.47, 60.32 ,55.395
Rx67457018200,RX,,67457018200,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESMOLOL HCL INJ 100 MG/10ML,1,30.08, 28.58 ,29.48, 28.58 , 29.18 , 28.58 ,Current Medicare Rates,29.18,28.88,Included in per diem,28.58,Included in ER Case rate,28.58,28.58, 29.48 ,27.072
Rx49281075278,RX,,49281075278,0250 - PHARMACY -  GENERAL CLASSIFICATION,TUBERCULIN PPD INJ 5 UNIT/0.1ML,1,26.12, 24.81 ,25.6, 24.81 , 25.34 , 24.81 ,Current Medicare Rates,25.34,25.08,Included in per diem,24.81,Included in ER Case rate,24.81,24.81, 25.60 ,23.508
Rx49281075221,RX,,49281075221,0250 - PHARMACY -  GENERAL CLASSIFICATION,TUBERCULIN PPD INJ 5 UNIT/0.1ML,1,26.04, 24.74 ,25.52, 24.74 , 25.26 , 24.74 ,Current Medicare Rates,25.26,25,Included in per diem,24.74,Included in ER Case rate,24.74,24.74, 25.52 ,23.436
Rx00009023301,RX,,00009023301,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN INTRAMUSCULAR FOR SOLN 50000 UNIT,1,27.11, 25.75 ,26.57, 25.75 , 26.30 , 25.75 ,Current Medicare Rates,26.3,26.03,Included in per diem,25.75,Included in ER Case rate,25.75,25.75, 26.57 ,24.399
Rx05928000100,RX,,05928000100,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYPERTONIC NASAL WASH - PACKET,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00264317511,RX,,00264317511,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFOTETAN DISODIUM FOR IV SOLN 2 GM AND DEXTROSE 2.08% 50 ML,1,114.42, 108.70 ,112.13, 108.70 , 110.99 , 108.70 ,Current Medicare Rates,110.99,109.84,Included in per diem,108.7,Included in ER Case rate,108.7,108.7, 112.13 ,102.978
Rx00409614309,RX,,00409614309,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETIC ACID IRRIGATION SOLN 0.25%,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00338065604,RX,,00338065604,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETIC ACID IRRIGATION SOLN 0.25%,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx63323040120,RX,,63323040120,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZTREONAM FOR INJ 1 GM,1,102.88, 97.74 ,100.82, 97.74 , 99.79 , 97.74 ,Current Medicare Rates,99.79,98.76,Included in per diem,97.74,Included in ER Case rate,97.74,97.74, 100.82 ,92.592
Rx00003257016,RX,,00003257016,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZTREONAM FOR INJ 2 GM,1,193.17, 183.51 ,189.31, 183.51 , 187.37 , 183.51 ,Current Medicare Rates,187.37,185.44,Included in per diem,183.51,Included in ER Case rate,183.51,183.51, 189.31 ,173.853
Rx63323040220,RX,,63323040220,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZTREONAM FOR INJ 2 GM,1,180.08, 171.08 ,176.48, 171.08 , 174.68 , 171.08 ,Current Medicare Rates,174.68,172.88,Included in per diem,171.08,Included in ER Case rate,171.08,171.08, 176.48 ,162.072
Rx49471000101,RX,,49471000101,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZYLPENICILLOYL POLYLYSINE INJ 0.25 ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409141204,RX,,00409141204,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUMETANIDE INJ 0.25 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641600801,RX,,00641600801,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUMETANIDE INJ 0.25 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409175550,RX,,00409175550,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323046357,RX,,63323046357,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPIVACAINE INJ 0.5% W/ EPINEPHRINE 1:200000,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00009085605,RX,,00009085605,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBOPROST TROMETHAMINE IM SOLN 250 MCG/ML,1,494.91, 470.16 ,485.01, 470.16 , 480.06 , 470.16 ,Current Medicare Rates,480.06,475.11,Included in per diem,470.16,Included in ER Case rate,470.16,470.16, 485.01 ,445.419
Rx17478079201,RX,,17478079201,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE HCL OPHTH GEL 3.5%,1,82.17, 78.06 ,80.53, 78.06 , 79.70 , 78.06 ,Current Medicare Rates,79.7,78.88,Included in per diem,78.06,Included in ER Case rate,78.06,78.06, 80.53 ,73.953
Rx10122032501,RX,,10122032501,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%,1,313.94, 298.24 ,307.66, 298.24 , 304.52 , 298.24 ,Current Medicare Rates,304.52,301.38,Included in per diem,298.24,Included in ER Case rate,298.24,298.24, 307.66 ,282.546
Rx43066001610,RX,,43066001610,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICARDIPINE HCL IV SOLN 40 MG/200ML IN SODIUM CHLORIDE 0.83%,1,304.57, 289.34 ,298.48, 289.34 , 295.43 , 289.34 ,Current Medicare Rates,295.43,292.39,Included in per diem,289.34,Included in ER Case rate,289.34,289.34, 298.48 ,274.113
Rx63323038510,RX,,63323038510,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFOTETAN DISODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457022800,RX,,67457022800,0250 - PHARMACY -  GENERAL CLASSIFICATION,ROCURONIUM BROMIDE IV SOLN 50 MG/5ML (10 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150022610,RX,,55150022610,0250 - PHARMACY -  GENERAL CLASSIFICATION,ROCURONIUM BROMIDE IV SOLN 100 MG/10ML (10 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781328991,RX,,00781328991,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 600 MG/50ML,1,52.22, 49.61 ,51.18, 49.61 , 50.65 , 49.61 ,Current Medicare Rates,50.65,50.13,Included in per diem,49.61,Included in ER Case rate,49.61,49.61, 51.18 ,46.998
Rx00009338201,RX,,00009338201,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML,1,124.14, 117.93 ,121.66, 117.93 , 120.42 , 117.93 ,Current Medicare Rates,120.42,119.17,Included in per diem,117.93,Included in ER Case rate,117.93,117.93, 121.66 ,111.726
Rx00781329091,RX,,00781329091,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLINDAMYCIN PHOSPHATE IN D5W IV SOLN 900 MG/50ML,1,56.86, 54.02 ,55.72, 54.02 , 55.15 , 54.02 ,Current Medicare Rates,55.15,54.59,Included in per diem,54.02,Included in ER Case rate,54.02,54.02, 55.72 ,51.174
Rx17478093705,RX,,17478093705,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641601301,RX,,00641601301,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx17478081705,RX,,17478081705,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL IV SOLN 25 MG/5ML (5 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641601501,RX,,00641601501,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx17478081725,RX,,17478081725,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL IV SOLN 125 MG/25ML (5 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx17478005002,RX,,17478005002,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUFENTANIL CITRATE INJ 100 MCG/2ML (50 MCG/ML),1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00143978701,RX,,00143978701,0250 - PHARMACY -  GENERAL CLASSIFICATION,ENALAPRILAT IV INJ 1.25 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00121065705,RX,,00121065705,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SOLN 160 MG/5ML,1,14.9, 14.16 ,14.6, 14.16 , 14.45 , 14.16 ,Current Medicare Rates,14.45,14.3,Included in per diem,14.16,Included in ER Case rate,14.16,14.16, 14.60 ,13.41
Rx00121065721,RX,,00121065721,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SOLN 160 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00121197121,RX,,00121197121,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SOLN 160 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00121197100,RX,,00121197100,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SOLN 160 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00172572860,RX,,00172572860,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079096601,RX,,51079096601,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE TAB 20 MG,1,6.1, 5.80 ,5.98, 5.80 , 5.92 , 5.80 ,Current Medicare Rates,5.92,5.86,Included in per diem,5.8,Included in ER Case rate,5.8,5.8, 5.98 ,5.49
Rx50268030311,RX,,50268030311,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739064510,RX,,63739064510,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx43386062230,RX,,43386062230,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVONORGESTREL TAB 1.5 MG,1,74.58, 70.85 ,73.09, 70.85 , 72.34 , 70.85 ,Current Medicare Rates,72.34,71.6,Included in per diem,70.85,Included in ER Case rate,70.85,70.85, 73.09 ,67.122
Rx51285014619,RX,,51285014619,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVONORGESTREL TAB 1.5 MG,1,122.51, 116.38 ,120.06, 116.38 , 118.83 , 116.38 ,Current Medicare Rates,118.83,117.61,Included in per diem,116.38,Included in ER Case rate,116.38,116.38, 120.06 ,110.259
Rx69536016288,RX,,69536016288,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVONORGESTREL TAB 1.5 MG,1,116.92, 111.07 ,114.58, 111.07 , 113.41 , 111.07 ,Current Medicare Rates,113.41,112.24,Included in per diem,111.07,Included in ER Case rate,111.07,111.07, 114.58 ,105.228
Rx16729009015,RX,,16729009015,0250 - PHARMACY -  GENERAL CLASSIFICATION,FINASTERIDE TAB 5 MG,1,5.99, 5.69 ,5.87, 5.69 , 5.81 , 5.69 ,Current Medicare Rates,5.81,5.75,Included in per diem,5.69,Included in ER Case rate,5.69,5.69, 5.87 ,5.391
Rx31722052590,RX,,31722052590,0250 - PHARMACY -  GENERAL CLASSIFICATION,FINASTERIDE TAB 5 MG,1,7.67, 7.29 ,7.52, 7.29 , 7.44 , 7.29 ,Current Medicare Rates,7.44,7.36,Included in per diem,7.29,Included in ER Case rate,7.29,7.29, 7.52 ,6.903
Rx68084039911,RX,,68084039911,0250 - PHARMACY -  GENERAL CLASSIFICATION,FINASTERIDE TAB 5 MG,1,7.14, 6.78 ,7, 6.78 , 6.93 , 6.78 ,Current Medicare Rates,6.93,6.85,Included in per diem,6.78,Included in ER Case rate,6.78,6.78, 7.00 ,6.426
Rx50268032311,RX,,50268032311,0250 - PHARMACY -  GENERAL CLASSIFICATION,FINASTERIDE TAB 5 MG,1,10.44, 9.92 ,10.23, 9.92 , 10.13 , 9.92 ,Current Medicare Rates,10.13,10.02,Included in per diem,9.92,Included in ER Case rate,9.92,9.92, 10.23 ,9.396
Rx00904683006,RX,,00904683006,0250 - PHARMACY -  GENERAL CLASSIFICATION,FINASTERIDE TAB 5 MG,1,8.58, 8.15 ,8.41, 8.15 , 8.32 , 8.15 ,Current Medicare Rates,8.32,8.24,Included in per diem,8.15,Included in ER Case rate,8.15,8.15, 8.41 ,7.722
Rx00054001020,RX,,00054001020,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLECAINIDE ACETATE TAB 50 MG,1,8.52, 8.09 ,8.35, 8.09 , 8.26 , 8.09 ,Current Medicare Rates,8.26,8.18,Included in per diem,8.09,Included in ER Case rate,8.09,8.09, 8.35 ,7.668
Rx00054001021,RX,,00054001021,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLECAINIDE ACETATE TAB 50 MG,1,8.67, 8.24 ,8.5, 8.24 , 8.41 , 8.24 ,Current Medicare Rates,8.41,8.32,Included in per diem,8.24,Included in ER Case rate,8.24,8.24, 8.50 ,7.803
Rx16714069101,RX,,16714069101,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUCONAZOLE TAB 100 MG,1,6.57, 6.24 ,6.44, 6.24 , 6.37 , 6.24 ,Current Medicare Rates,6.37,6.31,Included in per diem,6.24,Included in ER Case rate,6.24,6.24, 6.44 ,5.913
Rx68084072811,RX,,68084072811,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUCONAZOLE TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904650061,RX,,00904650061,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUCONAZOLE TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084028801,RX,,68084028801,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUDROCORTISONE ACETATE TAB 0.1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084028811,RX,,68084028811,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUDROCORTISONE ACETATE TAB 0.1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00555099702,RX,,00555099702,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUDROCORTISONE ACETATE TAB 0.1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx54799050721,RX,,54799050721,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUORESCEIN W/ PROPARACAINE OPHTH SOLN 0.25-0.5%,1,141.31, 134.24 ,138.48, 134.24 , 137.07 , 134.24 ,Current Medicare Rates,137.07,135.66,Included in per diem,134.24,Included in ER Case rate,134.24,134.24, 138.48 ,127.179
Rx00904578461,RX,,00904578461,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUOXETINE HCL CAP 10 MG,1,6.11, 5.80 ,5.99, 5.80 , 5.93 , 5.80 ,Current Medicare Rates,5.93,5.87,Included in per diem,5.8,Included in ER Case rate,5.8,5.8, 5.99 ,5.499
Rx00904578561,RX,,00904578561,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUOXETINE HCL CAP 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084060511,RX,,68084060511,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUOXETINE HCL CAP 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904663761,RX,,00904663761,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIPIZIDE TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079081001,RX,,51079081001,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIPIZIDE TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084046301,RX,,68084046301,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT),1,10.79, 10.25 ,10.57, 10.25 , 10.47 , 10.25 ,Current Medicare Rates,10.47,10.36,Included in per diem,10.25,Included in ER Case rate,10.25,10.25, 10.57 ,9.711
Rx68084046311,RX,,68084046311,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT),1,12.55, 11.92 ,12.3, 11.92 , 12.17 , 11.92 ,Current Medicare Rates,12.17,12.05,Included in per diem,11.92,Included in ER Case rate,11.92,11.92, 12.30 ,11.295
Rx69452015120,RX,,69452015120,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT),1,7.57, 7.19 ,7.42, 7.19 , 7.34 , 7.19 ,Current Medicare Rates,7.34,7.27,Included in per diem,7.19,Included in ER Case rate,7.19,7.19, 7.42 ,6.813
Rx50268029711,RX,,50268029711,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT),1,10.93, 10.38 ,10.71, 10.38 , 10.60 , 10.38 ,Current Medicare Rates,10.6,10.49,Included in per diem,10.38,Included in ER Case rate,10.38,10.38, 10.71 ,9.837
Rx50268029715,RX,,50268029715,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT),1,11.79, 11.20 ,11.55, 11.20 , 11.44 , 11.20 ,Current Medicare Rates,11.44,11.32,Included in per diem,11.2,Included in ER Case rate,11.2,11.2, 11.55 ,10.611
Rx50111099001,RX,,50111099001,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERGOCALCIFEROL CAP 1.25 MG (50000 UNIT),1,8.14, 7.73 ,7.98, 7.73 , 7.90 , 7.73 ,Current Medicare Rates,7.9,7.81,Included in per diem,7.73,Included in ER Case rate,7.73,7.73, 7.98 ,7.326
Rx63739056710,RX,,63739056710,0250 - PHARMACY -  GENERAL CLASSIFICATION,TAMSULOSIN HCL CAP 0.4 MG,1,7.47, 7.10 ,7.32, 7.10 , 7.25 , 7.10 ,Current Medicare Rates,7.25,7.17,Included in per diem,7.1,Included in ER Case rate,7.1,7.1, 7.32 ,6.723
Rx68084029901,RX,,68084029901,0250 - PHARMACY -  GENERAL CLASSIFICATION,TAMSULOSIN HCL CAP 0.4 MG,1,6.82, 6.48 ,6.68, 6.48 , 6.62 , 6.48 ,Current Medicare Rates,6.62,6.55,Included in per diem,6.48,Included in ER Case rate,6.48,6.48, 6.68 ,6.138
Rx68084029911,RX,,68084029911,0250 - PHARMACY -  GENERAL CLASSIFICATION,TAMSULOSIN HCL CAP 0.4 MG,1,6.98, 6.63 ,6.84, 6.63 , 6.77 , 6.63 ,Current Medicare Rates,6.77,6.7,Included in per diem,6.63,Included in ER Case rate,6.63,6.63, 6.84 ,6.282
Rx00904640161,RX,,00904640161,0250 - PHARMACY -  GENERAL CLASSIFICATION,TAMSULOSIN HCL CAP 0.4 MG,1,6.74, 6.40 ,6.61, 6.40 , 6.54 , 6.40 ,Current Medicare Rates,6.54,6.47,Included in per diem,6.4,Included in ER Case rate,6.4,6.4, 6.61 ,6.066
Rx59762007301,RX,,59762007301,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE TAB 5 MG,1,6.57, 6.24 ,6.44, 6.24 , 6.37 , 6.24 ,Current Medicare Rates,6.37,6.31,Included in per diem,6.24,Included in ER Case rate,6.24,6.24, 6.44 ,5.913
Rx00574202001,RX,,00574202001,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE ENEMA 100 MG/60ML,1,42.54, 40.41 ,41.69, 40.41 , 41.26 , 40.41 ,Current Medicare Rates,41.26,40.84,Included in per diem,40.41,Included in ER Case rate,40.41,40.41, 41.69 ,38.286
Rx62559013807,RX,,62559013807,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE ENEMA 100 MG/60ML,1,26.41, 25.09 ,25.88, 25.09 , 25.62 , 25.09 ,Current Medicare Rates,25.62,25.35,Included in per diem,25.09,Included in ER Case rate,25.09,25.09, 25.88 ,23.769
Rx00472125594,RX,,00472125594,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN SUSP 100 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68094049459,RX,,68094049459,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN SUSP 100 MG/5ML,1,6.51, 6.18 ,6.38, 6.18 , 6.31 , 6.18 ,Current Medicare Rates,6.31,6.25,Included in per diem,6.18,Included in ER Case rate,6.18,6.18, 6.38 ,5.859
Rx00121477405,RX,,00121477405,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN SUSP 100 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx45802073200,RX,,45802073200,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUPPOS 120 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00713011806,RX,,00713011806,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUPPOS 120 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx45802073230,RX,,45802073230,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUPPOS 120 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00168004015,RX,,00168004015,0250 - PHARMACY -  GENERAL CLASSIFICATION,BETAMETHASONE VALERATE CREAM 0.1% (BASE EQUIVALENT),1,85.22, 80.96 ,83.52, 80.96 , 82.66 , 80.96 ,Current Medicare Rates,82.66,81.81,Included in per diem,80.96,Included in ER Case rate,80.96,80.96, 83.52 ,76.698
Rx00168003315,RX,,00168003315,0250 - PHARMACY -  GENERAL CLASSIFICATION,BETAMETHASONE VALERATE OINT 0.1% (BASE EQUIVALENT),1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00168009915,RX,,00168009915,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOCONAZOLE CREAM 2%,1,36.36, 34.54 ,35.63, 34.54 , 35.27 , 34.54 ,Current Medicare Rates,35.27,34.91,Included in per diem,34.54,Included in ER Case rate,34.54,34.54, 35.63 ,32.724
Rx51672129801,RX,,51672129801,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOCONAZOLE CREAM 2%,1,86.33, 82.01 ,84.6, 82.01 , 83.74 , 82.01 ,Current Medicare Rates,83.74,82.88,Included in per diem,82.01,Included in ER Case rate,82.01,82.01, 84.60 ,77.697
Rx35573043330,RX,,35573043330,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOCONAZOLE TAB 200 MG,1,10.64, 10.11 ,10.43, 10.11 , 10.32 , 10.11 ,Current Medicare Rates,10.32,10.21,Included in per diem,10.11,Included in ER Case rate,10.11,10.11, 10.43 ,9.576
Rx51672402606,RX,,51672402606,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOCONAZOLE TAB 200 MG,1,11.09, 10.54 ,10.87, 10.54 , 10.76 , 10.54 ,Current Medicare Rates,10.76,10.65,Included in per diem,10.54,Included in ER Case rate,10.54,10.54, 10.87 ,9.981
Rx00378113401,RX,,00378113401,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOROLAC TROMETHAMINE TAB 10 MG,1,15.15, 14.39 ,14.85, 14.39 , 14.70 , 14.39 ,Current Medicare Rates,14.7,14.54,Included in per diem,14.39,Included in ER Case rate,14.39,14.39, 14.85 ,13.635
Rx60687010411,RX,,60687010411,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOROLAC TROMETHAMINE TAB 10 MG,1,22.05, 20.95 ,21.61, 20.95 , 21.39 , 20.95 ,Current Medicare Rates,21.39,21.17,Included in per diem,20.95,Included in ER Case rate,20.95,20.95, 21.61 ,19.845
Rx00093031401,RX,,00093031401,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOROLAC TROMETHAMINE TAB 10 MG,1,9.87, 9.38 ,9.67, 9.38 , 9.57 , 9.38 ,Current Medicare Rates,9.57,9.48,Included in per diem,9.38,Included in ER Case rate,9.38,9.38, 9.67 ,8.883
Rx00904592861,RX,,00904592861,0250 - PHARMACY -  GENERAL CLASSIFICATION,LABETALOL HCL TAB 100 MG,1,6.89, 6.55 ,6.75, 6.55 , 6.68 , 6.55 ,Current Medicare Rates,6.68,6.61,Included in per diem,6.55,Included in ER Case rate,6.55,6.55, 6.75 ,6.201
Rx60687011411,RX,,60687011411,0250 - PHARMACY -  GENERAL CLASSIFICATION,LABETALOL HCL TAB 100 MG,1,7.2, 6.84 ,7.06, 6.84 , 6.98 , 6.84 ,Current Medicare Rates,6.98,6.91,Included in per diem,6.84,Included in ER Case rate,6.84,6.84, 7.06 ,6.48
Rx71247012601,RX,,71247012601,0250 - PHARMACY -  GENERAL CLASSIFICATION,LABETALOL HCL TAB 100 MG,1,7.82, 7.43 ,7.66, 7.43 , 7.59 , 7.43 ,Current Medicare Rates,7.59,7.51,Included in per diem,7.43,Included in ER Case rate,7.43,7.43, 7.66 ,7.038
Rx00713016406,RX,,00713016406,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUPPOS 325 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx51672211604,RX,,51672211604,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUPPOS 325 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx51672211600,RX,,51672211600,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUPPOS 325 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00378180701,RX,,00378180701,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 88 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42292003801,RX,,42292003801,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 88 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00074929690,RX,,00074929690,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 112 MCG,1,12.8, 12.16 ,12.54, 12.16 , 12.42 , 12.16 ,Current Medicare Rates,12.42,12.29,Included in per diem,12.16,Included in ER Case rate,12.16,12.16, 12.54 ,11.52
Rx00378181177,RX,,00378181177,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 112 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42292003920,RX,,42292003920,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 112 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42292003901,RX,,42292003901,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 112 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687050801,RX,,60687050801,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 112 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687050811,RX,,60687050811,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 112 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00074372790,RX,,00074372790,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 137 MCG,1,9.34, 8.87 ,9.15, 8.87 , 9.06 , 8.87 ,Current Medicare Rates,9.06,8.97,Included in per diem,8.87,Included in ER Case rate,8.87,8.87, 9.15 ,8.406
Rx00378182377,RX,,00378182377,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 137 MCG,1,6.26, 5.95 ,6.13, 5.95 , 6.07 , 5.95 ,Current Medicare Rates,6.07,6.01,Included in per diem,5.95,Included in ER Case rate,5.95,5.95, 6.13 ,5.634
Rx42292004101,RX,,42292004101,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 137 MCG,1,6.34, 6.02 ,6.21, 6.02 , 6.15 , 6.02 ,Current Medicare Rates,6.15,6.09,Included in per diem,6.02,Included in ER Case rate,6.02,6.02, 6.21 ,5.706
Rx42292004120,RX,,42292004120,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 137 MCG,1,6.33, 6.01 ,6.2, 6.01 , 6.14 , 6.01 ,Current Medicare Rates,6.14,6.08,Included in per diem,6.01,Included in ER Case rate,6.01,6.01, 6.20 ,5.697
Rx00168035755,RX,,00168035755,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,1,32.81, 31.17 ,32.15, 31.17 , 31.83 , 31.17 ,Current Medicare Rates,31.83,31.5,Included in per diem,31.17,Included in ER Case rate,31.17,31.17, 32.15 ,29.529
Rx00115146860,RX,,00115146860,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,1,22.67, 21.54 ,22.22, 21.54 , 21.99 , 21.54 ,Current Medicare Rates,21.99,21.76,Included in per diem,21.54,Included in ER Case rate,21.54,21.54, 22.22 ,20.403
Rx00115146853,RX,,00115146853,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,1,22.94, 21.79 ,22.48, 21.79 , 22.25 , 21.79 ,Current Medicare Rates,22.25,22.02,Included in per diem,21.79,Included in ER Case rate,21.79,21.79, 22.48 ,20.646
Rx00168035705,RX,,00168035705,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE-PRILOCAINE CREAM 2.5-2.5%,1,30.68, 29.15 ,30.07, 29.15 , 29.76 , 29.15 ,Current Medicare Rates,29.76,29.45,Included in per diem,29.15,Included in ER Case rate,29.15,29.15, 30.07 ,27.612
Rx51079098201,RX,,51079098201,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 10 MG,1,5.94, 5.64 ,5.82, 5.64 , 5.76 , 5.64 ,Current Medicare Rates,5.76,5.7,Included in per diem,5.64,Included in ER Case rate,5.64,5.64, 5.82 ,5.346
Rx63739034910,RX,,63739034910,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739034943,RX,,63739034943,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904679861,RX,,00904679861,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00591040601,RX,,00591040601,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904679761,RX,,00904679761,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00054002025,RX,,00054002025,0250 - PHARMACY -  GENERAL CLASSIFICATION,LITHIUM CARBONATE TAB ER 450 MG,1,7.91, 7.51 ,7.75, 7.51 , 7.67 , 7.51 ,Current Medicare Rates,7.67,7.59,Included in per diem,7.51,Included in ER Case rate,7.51,7.51, 7.75 ,7.119
Rx51079014201,RX,,51079014201,0250 - PHARMACY -  GENERAL CLASSIFICATION,LITHIUM CARBONATE TAB ER 450 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084065501,RX,,68084065501,0250 - PHARMACY -  GENERAL CLASSIFICATION,LITHIUM CARBONATE TAB ER 450 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084065511,RX,,68084065511,0250 - PHARMACY -  GENERAL CLASSIFICATION,LITHIUM CARBONATE TAB ER 450 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx54162018525,RX,,54162018525,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINERAL OIL LIGHT (TOPICAL),1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx68084024811,RX,,68084024811,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORATADINE TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739028110,RX,,63739028110,0250 - PHARMACY -  GENERAL CLASSIFICATION,LOVASTATIN TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68180046801,RX,,68180046801,0250 - PHARMACY -  GENERAL CLASSIFICATION,LOVASTATIN TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx45802073000,RX,,45802073000,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUPPOS 650 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00904632661,RX,,00904632661,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB 500 MG,1,5.89, 5.60 ,5.77, 5.60 , 5.71 , 5.60 ,Current Medicare Rates,5.71,5.65,Included in per diem,5.6,Included in ER Case rate,5.6,5.6, 5.77 ,5.301
Rx63739064010,RX,,63739064010,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB 500 MG,1,5.95, 5.65 ,5.83, 5.65 , 5.77 , 5.65 ,Current Medicare Rates,5.77,5.71,Included in per diem,5.65,Included in ER Case rate,5.65,5.65, 5.83 ,5.355
Rx00904668961,RX,,00904668961,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB 500 MG,1,5.95, 5.65 ,5.83, 5.65 , 5.77 , 5.65 ,Current Medicare Rates,5.77,5.71,Included in per diem,5.65,Included in ER Case rate,5.65,5.65, 5.83 ,5.355
Rx68084027511,RX,,68084027511,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHIMAZOLE TAB 5 MG,1,8.18, 7.77 ,8.02, 7.77 , 7.93 , 7.77 ,Current Medicare Rates,7.93,7.85,Included in per diem,7.77,Included in ER Case rate,7.77,7.77, 8.02 ,7.362
Rx60687035701,RX,,60687035701,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHIMAZOLE TAB 5 MG,1,7.52, 7.14 ,7.37, 7.14 , 7.29 , 7.14 ,Current Medicare Rates,7.29,7.22,Included in per diem,7.14,Included in ER Case rate,7.14,7.14, 7.37 ,6.768
Rx60687035711,RX,,60687035711,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHIMAZOLE TAB 5 MG,1,7.53, 7.15 ,7.38, 7.15 , 7.30 , 7.15 ,Current Medicare Rates,7.3,7.23,Included in per diem,7.15,Included in ER Case rate,7.15,7.15, 7.38 ,6.777
Rx27437005057,RX,,27437005057,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHYLERGONOVINE MALEATE TAB 0.2 MG,1,163.43, 155.26 ,160.16, 155.26 , 158.53 , 155.26 ,Current Medicare Rates,158.53,156.89,Included in per diem,155.26,Included in ER Case rate,155.26,155.26, 160.16 ,147.087
Rx00054063905,RX,,00054063905,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHYLERGONOVINE MALEATE TAB 0.2 MG,1,140.74, 133.70 ,137.93, 133.70 , 136.52 , 133.70 ,Current Medicare Rates,136.52,135.11,Included in per diem,133.7,Included in ER Case rate,133.7,133.7, 137.93 ,126.666
Rx69238160502,RX,,69238160502,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHYLERGONOVINE MALEATE TAB 0.2 MG,1,62.71, 59.57 ,61.46, 59.57 , 60.83 , 59.57 ,Current Medicare Rates,60.83,60.2,Included in per diem,59.57,Included in ER Case rate,59.57,59.57, 61.46 ,56.439
Rx51079002401,RX,,51079002401,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOLAZONE TAB 5 MG,1,10.43, 9.91 ,10.22, 9.91 , 10.12 , 9.91 ,Current Medicare Rates,10.12,10.01,Included in per diem,9.91,Included in ER Case rate,9.91,9.91, 10.22 ,9.387
Rx00185005501,RX,,00185005501,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOLAZONE TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx37000002410,RX,,37000002410,0250 - PHARMACY -  GENERAL CLASSIFICATION,PSYLLIUM POWDER PACKET 58.12%,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079045301,RX,,51079045301,0250 - PHARMACY -  GENERAL CLASSIFICATION,MIDODRINE HCL TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079045320,RX,,51079045320,0250 - PHARMACY -  GENERAL CLASSIFICATION,MIDODRINE HCL TAB 5 MG,1,5.81, 5.52 ,5.69, 5.52 , 5.64 , 5.52 ,Current Medicare Rates,5.64,5.58,Included in per diem,5.52,Included in ER Case rate,5.52,5.52, 5.69 ,5.229
Rx60505132101,RX,,60505132101,0250 - PHARMACY -  GENERAL CLASSIFICATION,MIDODRINE HCL TAB 5 MG,1,9.51, 9.03 ,9.32, 9.03 , 9.22 , 9.03 ,Current Medicare Rates,9.22,9.13,Included in per diem,9.03,Included in ER Case rate,9.03,9.03, 9.32 ,8.559
Rx68084004011,RX,,68084004011,0250 - PHARMACY -  GENERAL CLASSIFICATION,MISOPROSTOL TAB 100 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00025145134,RX,,00025145134,0250 - PHARMACY -  GENERAL CLASSIFICATION,MISOPROSTOL TAB 100 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51672131200,RX,,51672131200,0250 - PHARMACY -  GENERAL CLASSIFICATION,MUPIROCIN OINT 2%,1,16.46, 15.64 ,16.13, 15.64 , 15.97 , 15.64 ,Current Medicare Rates,15.97,15.8,Included in per diem,15.64,Included in ER Case rate,15.64,15.64, 16.13 ,14.814
Rx68462018022,RX,,68462018022,0250 - PHARMACY -  GENERAL CLASSIFICATION,MUPIROCIN OINT 2%,1,38.54, 36.61 ,37.77, 36.61 , 37.38 , 36.61 ,Current Medicare Rates,37.38,37,Included in per diem,36.61,Included in ER Case rate,36.61,36.61, 37.77 ,34.686
Rx45802011222,RX,,45802011222,0250 - PHARMACY -  GENERAL CLASSIFICATION,MUPIROCIN OINT 2%,1,38.54, 36.61 ,37.77, 36.61 , 37.38 , 36.61 ,Current Medicare Rates,37.38,37,Included in per diem,36.61,Included in ER Case rate,36.61,36.61, 37.77 ,34.686
Rx68084029111,RX,,68084029111,0250 - PHARMACY -  GENERAL CLASSIFICATION,NALTREXONE HCL TAB 50 MG,1,7.02, 6.67 ,6.88, 6.67 , 6.81 , 6.67 ,Current Medicare Rates,6.81,6.74,Included in per diem,6.67,Included in ER Case rate,6.67,6.67, 6.88 ,6.318
Rx51224020630,RX,,51224020630,0250 - PHARMACY -  GENERAL CLASSIFICATION,NALTREXONE HCL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68094085362,RX,,68094085362,0250 - PHARMACY -  GENERAL CLASSIFICATION,NALTREXONE HCL TAB 50 MG,1,8.8, 8.36 ,8.62, 8.36 , 8.54 , 8.36 ,Current Medicare Rates,8.54,8.45,Included in per diem,8.36,Included in ER Case rate,8.36,8.36, 8.62 ,7.92
Rx50458058030,RX,,50458058030,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIVAROXABAN TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx50458058010,RX,,50458058010,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIVAROXABAN TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx50458058001,RX,,50458058001,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIVAROXABAN TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084044601,RX,,68084044601,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG,1,18.99, 18.04 ,18.61, 18.04 , 18.42 , 18.04 ,Current Medicare Rates,18.42,18.23,Included in per diem,18.04,Included in ER Case rate,18.04,18.04, 18.61 ,17.091
Rx68084044611,RX,,68084044611,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG,1,17.71, 16.82 ,17.36, 16.82 , 17.18 , 16.82 ,Current Medicare Rates,17.18,17,Included in per diem,16.82,Included in ER Case rate,16.82,16.82, 17.36 ,15.939
Rx16714043901,RX,,16714043901,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MONOHYDRATE MACROCRYSTALLINE CAP 100 MG,1,19.27, 18.31 ,18.88, 18.31 , 18.69 , 18.31 ,Current Medicare Rates,18.69,18.5,Included in per diem,18.31,Included in ER Case rate,18.31,18.31, 18.88 ,17.343
Rx52015008001,RX,,52015008001,0250 - PHARMACY -  GENERAL CLASSIFICATION,FIDAXOMICIN TAB 200 MG,1,506.99, 481.64 ,496.85, 481.64 , 491.78 , 481.64 ,Current Medicare Rates,491.78,486.71,Included in per diem,481.64,Included in ER Case rate,481.64,481.64, 496.85 ,456.291
Rx00904640761,RX,,00904640761,0250 - PHARMACY -  GENERAL CLASSIFICATION,BISACODYL TAB DELAYED RELEASE 5 MG,1,5.8, 5.51 ,5.68, 5.51 , 5.63 , 5.51 ,Current Medicare Rates,5.63,5.57,Included in per diem,5.51,Included in ER Case rate,5.51,5.51, 5.68 ,5.22
Rx00574705012,RX,,00574705012,0250 - PHARMACY -  GENERAL CLASSIFICATION,BISACODYL SUPPOS 10 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68784010212,RX,,68784010212,0250 - PHARMACY -  GENERAL CLASSIFICATION,BISACODYL SUPPOS 10 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00527142636,RX,,00527142636,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML),1,7.42, 7.05 ,7.27, 7.05 , 7.20 , 7.05 ,Current Medicare Rates,7.2,7.12,Included in per diem,7.05,Included in ER Case rate,7.05,7.05, 7.27 ,6.678
Rx00000001551,RX,,00000001551,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx66689002530,RX,,66689002530,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML),1,7.63, 7.25 ,7.48, 7.25 , 7.40 , 7.25 ,Current Medicare Rates,7.4,7.32,Included in per diem,7.25,Included in ER Case rate,7.25,7.25, 7.48 ,6.867
Rx68308002003,RX,,68308002003,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL CONC 100 MG/5ML (20 MG/ML),1,7.63, 7.25 ,7.48, 7.25 , 7.40 , 7.25 ,Current Medicare Rates,7.4,7.32,Included in per diem,7.25,Included in ER Case rate,7.25,7.25, 7.48 ,6.867
Rx64950035405,RX,,64950035405,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL SOLN 5 MG/5ML,1,25.44, 24.17 ,24.93, 24.17 , 24.68 , 24.17 ,Current Medicare Rates,24.68,24.42,Included in per diem,24.17,Included in ER Case rate,24.17,24.17, 24.93 ,22.896
Rx00121483905,RX,,00121483905,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL SOLN 5 MG/5ML,1,19.49, 18.52 ,19.1, 18.52 , 18.91 , 18.52 ,Current Medicare Rates,18.91,18.71,Included in per diem,18.52,Included in ER Case rate,18.52,18.52, 19.10 ,17.541
Rx00904682805,RX,,00904682805,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL SOLN 5 MG/5ML,1,16.75, 15.91 ,16.42, 15.91 , 16.25 , 15.91 ,Current Medicare Rates,16.25,16.08,Included in per diem,15.91,Included in ER Case rate,15.91,15.91, 16.42 ,15.075
Rx00121482705,RX,,00121482705,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL SOLN 5 MG/5ML,1,17.66, 16.78 ,17.31, 16.78 , 17.13 , 16.78 ,Current Medicare Rates,17.13,16.95,Included in per diem,16.78,Included in ER Case rate,16.78,16.78, 17.31 ,15.894
Rx00121482740,RX,,00121482740,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL SOLN 5 MG/5ML,1,11.44, 10.87 ,11.21, 10.87 , 11.10 , 10.87 ,Current Medicare Rates,11.1,10.98,Included in per diem,10.87,Included in ER Case rate,10.87,10.87, 11.21 ,10.296
Rx68084035401,RX,,68084035401,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 5 MG,1,8.56, 8.13 ,8.39, 8.13 , 8.30 , 8.13 ,Current Medicare Rates,8.3,8.22,Included in per diem,8.13,Included in ER Case rate,8.13,8.13, 8.39 ,7.704
Rx68084035411,RX,,68084035411,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 5 MG,1,8.34, 7.92 ,8.17, 7.92 , 8.09 , 7.92 ,Current Medicare Rates,8.09,8.01,Included in per diem,7.92,Included in ER Case rate,7.92,7.92, 8.17 ,7.506
Rx00904644461,RX,,00904644461,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 5 MG,1,7.38, 7.01 ,7.23, 7.01 , 7.16 , 7.01 ,Current Medicare Rates,7.16,7.08,Included in per diem,7.01,Included in ER Case rate,7.01,7.01, 7.23 ,6.642
Rx68308050547,RX,,68308050547,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 5 MG,1,8.42, 8.00 ,8.25, 8.00 , 8.17 , 8.00 ,Current Medicare Rates,8.17,8.08,Included in per diem,8,Included in ER Case rate,8,8, 8.25 ,7.578
Rx00406055223,RX,,00406055223,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 5 MG,1,6.91, 6.56 ,6.77, 6.56 , 6.70 , 6.56 ,Current Medicare Rates,6.7,6.63,Included in per diem,6.56,Included in ER Case rate,6.56,6.56, 6.77 ,6.219
Rx68084004511,RX,,68084004511,0250 - PHARMACY -  GENERAL CLASSIFICATION,PAROXETINE HCL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904567761,RX,,00904567761,0250 - PHARMACY -  GENERAL CLASSIFICATION,PAROXETINE HCL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00472024260,RX,,00472024260,0250 - PHARMACY -  GENERAL CLASSIFICATION,PERMETHRIN CREAM 5%,1,306.29, 290.98 ,300.16, 290.98 , 297.10 , 290.98 ,Current Medicare Rates,297.1,294.04,Included in per diem,290.98,Included in ER Case rate,290.98,290.98, 300.16 ,275.661
Rx40085021560,RX,,40085021560,0250 - PHARMACY -  GENERAL CLASSIFICATION,PERMETHRIN CREAM 5%,1,309.5, 294.03 ,303.31, 294.03 , 300.22 , 294.03 ,Current Medicare Rates,300.22,297.12,Included in per diem,294.03,Included in ER Case rate,294.03,294.03, 303.31 ,278.55
Rx16714089701,RX,,16714089701,0250 - PHARMACY -  GENERAL CLASSIFICATION,PERMETHRIN CREAM 5%,1,307.09, 291.74 ,300.95, 291.74 , 297.88 , 291.74 ,Current Medicare Rates,297.88,294.81,Included in per diem,291.74,Included in ER Case rate,291.74,291.74, 300.95 ,276.381
Rx45802026937,RX,,45802026937,0250 - PHARMACY -  GENERAL CLASSIFICATION,PERMETHRIN CREAM 5%,1,306.29, 290.98 ,300.16, 290.98 , 297.10 , 290.98 ,Current Medicare Rates,297.1,294.04,Included in per diem,290.98,Included in ER Case rate,290.98,290.98, 300.16 ,275.661
Rx00574416035,RX,,00574416035,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%,1,54.5, 51.78 ,53.41, 51.78 , 52.87 , 51.78 ,Current Medicare Rates,52.87,52.32,Included in per diem,51.78,Included in ER Case rate,51.78,51.78, 53.41 ,49.05
Rx24208079535,RX,,24208079535,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%,1,67.76, 64.37 ,66.4, 64.37 , 65.73 , 64.37 ,Current Medicare Rates,65.73,65.05,Included in per diem,64.37,Included in ER Case rate,64.37,64.37, 66.40 ,60.984
Rx61314063136,RX,,61314063136,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-POLYMYXIN-DEXAMETHASONE OPHTH OINT 0.1%,1,46.81, 44.47 ,45.87, 44.47 , 45.41 , 44.47 ,Current Medicare Rates,45.41,44.94,Included in per diem,44.47,Included in ER Case rate,44.47,44.47, 45.87 ,42.129
Rx00597014960,RX,,00597014960,0250 - PHARMACY -  GENERAL CLASSIFICATION,DABIGATRAN ETEXILATE MESYLATE CAP 75 MG (ETEXILATE BASE EQ),1,21.62, 20.54 ,21.19, 20.54 , 20.97 , 20.54 ,Current Medicare Rates,20.97,20.76,Included in per diem,20.54,Included in ER Case rate,20.54,20.54, 21.19 ,19.458
Rx00187170405,RX,,00187170405,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHYTONADIONE TAB 5 MG,1,129.91, 123.41 ,127.31, 123.41 , 126.01 , 123.41 ,Current Medicare Rates,126.01,124.71,Included in per diem,123.41,Included in ER Case rate,123.41,123.41, 127.31 ,116.919
Rx69238105101,RX,,69238105101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHYTONADIONE TAB 5 MG,1,70.71, 67.17 ,69.3, 67.17 , 68.59 , 67.17 ,Current Medicare Rates,68.59,67.88,Included in per diem,67.17,Included in ER Case rate,67.17,67.17, 69.30 ,63.639
Rx60687038111,RX,,60687038111,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHYTONADIONE TAB 5 MG,1,76.16, 72.35 ,74.64, 72.35 , 73.88 , 72.35 ,Current Medicare Rates,73.88,73.11,Included in per diem,72.35,Included in ER Case rate,72.35,72.35, 74.64 ,68.544
Rx60687038194,RX,,60687038194,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHYTONADIONE TAB 5 MG,1,88.15, 83.74 ,86.39, 83.74 , 85.51 , 83.74 ,Current Medicare Rates,85.51,84.62,Included in per diem,83.74,Included in ER Case rate,83.74,83.74, 86.39 ,79.335
Rx00005250002,RX,,00005250002,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM POLYCARBOPHIL TAB 625 MG,1,6.54, 6.21 ,6.41, 6.21 , 6.34 , 6.21 ,Current Medicare Rates,6.34,6.28,Included in per diem,6.21,Included in ER Case rate,6.21,6.21, 6.41 ,5.886
Rx00536430611,RX,,00536430611,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM POLYCARBOPHIL TAB 625 MG,1,5.94, 5.64 ,5.82, 5.64 , 5.76 , 5.64 ,Current Medicare Rates,5.76,5.7,Included in per diem,5.64,Included in ER Case rate,5.64,5.64, 5.82 ,5.346
Rx77333011810,RX,,77333011810,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM POLYCARBOPHIL TAB 625 MG,1,6.46, 6.14 ,6.33, 6.14 , 6.27 , 6.14 ,Current Medicare Rates,6.27,6.2,Included in per diem,6.14,Included in ER Case rate,6.14,6.14, 6.33 ,5.814
Rx77333011825,RX,,77333011825,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM POLYCARBOPHIL TAB 625 MG,1,6.26, 5.95 ,6.13, 5.95 , 6.07 , 5.95 ,Current Medicare Rates,6.07,6.01,Included in per diem,5.95,Included in ER Case rate,5.95,5.95, 6.13 ,5.634
Rx00004082205,RX,,00004082205,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),1,120.45, 114.43 ,118.04, 114.43 , 116.84 , 114.43 ,Current Medicare Rates,116.84,115.63,Included in per diem,114.43,Included in ER Case rate,114.43,114.43, 118.04 ,108.405
Rx47781038426,RX,,47781038426,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),1,89.45, 84.98 ,87.66, 84.98 , 86.77 , 84.98 ,Current Medicare Rates,86.77,85.87,Included in per diem,84.98,Included in ER Case rate,84.98,84.98, 87.66 ,80.505
Rx68180067801,RX,,68180067801,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),1,25.37, 24.10 ,24.86, 24.10 , 24.61 , 24.10 ,Current Medicare Rates,24.61,24.36,Included in per diem,24.1,Included in ER Case rate,24.1,24.1, 24.86 ,22.833
Rx00093818064,RX,,00093818064,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE FOR SUSP 6 MG/ML (BASE EQUIV),1,61.81, 58.72 ,60.57, 58.72 , 59.96 , 58.72 ,Current Medicare Rates,59.96,59.34,Included in per diem,58.72,Included in ER Case rate,58.72,58.72, 60.57 ,55.629
Rx00486111101,RX,,00486111101,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM PHOSPHATE MONOBASIC TAB 500 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx51079045801,RX,,51079045801,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAVASTATIN SODIUM TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904589261,RX,,00904589261,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAVASTATIN SODIUM TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084050101,RX,,68084050101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAVASTATIN SODIUM TAB 20 MG,1,8.89, 8.45 ,8.71, 8.45 , 8.62 , 8.45 ,Current Medicare Rates,8.62,8.53,Included in per diem,8.45,Included in ER Case rate,8.45,8.45, 8.71 ,8.001
Rx50419074701,RX,,50419074701,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAZIQUANTEL TAB 600 MG,1,197.54, 187.66 ,193.59, 187.66 , 191.61 , 187.66 ,Current Medicare Rates,191.61,189.64,Included in per diem,187.66,Included in ER Case rate,187.66,187.66, 193.59 ,177.786
Rx00603537121,RX,,00603537121,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRIMIDONE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68084020211,RX,,68084020211,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRIMIDONE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx50268068611,RX,,50268068611,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRIMIDONE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00574722612,RX,,00574722612,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROCHLORPERAZINE SUPPOS 25 MG,1,15.54, 14.76 ,15.23, 14.76 , 15.07 , 14.76 ,Current Medicare Rates,15.07,14.92,Included in per diem,14.76,Included in ER Case rate,14.76,14.76, 15.23 ,13.986
Rx00713013512,RX,,00713013512,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROCHLORPERAZINE SUPPOS 25 MG,1,11.37, 10.80 ,11.14, 10.80 , 11.03 , 10.80 ,Current Medicare Rates,11.03,10.92,Included in per diem,10.8,Included in ER Case rate,10.8,10.8, 11.14 ,10.233
Rx00591298539,RX,,00591298539,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL SUPPOS 12.5 MG,1,32.47, 30.85 ,31.82, 30.85 , 31.50 , 30.85 ,Current Medicare Rates,31.5,31.17,Included in per diem,30.85,Included in ER Case rate,30.85,30.85, 31.82 ,29.223
Rx51672529600,RX,,51672529600,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL SUPPOS 12.5 MG,1,32.32, 30.70 ,31.67, 30.70 , 31.35 , 30.70 ,Current Medicare Rates,31.35,31.03,Included in per diem,30.7,Included in ER Case rate,30.7,30.7, 31.67 ,29.088
Rx00591299239,RX,,00591299239,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL SUPPOS 25 MG,1,17.39, 16.52 ,17.04, 16.52 , 16.87 , 16.52 ,Current Medicare Rates,16.87,16.69,Included in per diem,16.52,Included in ER Case rate,16.52,16.52, 17.04 ,15.651
Rx45802075900,RX,,45802075900,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL SUPPOS 25 MG,1,17.44, 16.57 ,17.09, 16.57 , 16.92 , 16.57 ,Current Medicare Rates,16.92,16.74,Included in per diem,16.57,Included in ER Case rate,16.57,16.57, 17.09 ,15.696
Rx51672529701,RX,,51672529701,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL SUPPOS 25 MG,1,17.31, 16.44 ,16.96, 16.44 , 16.79 , 16.44 ,Current Medicare Rates,16.79,16.62,Included in per diem,16.44,Included in ER Case rate,16.44,16.44, 16.96 ,15.579
Rx45802075930,RX,,45802075930,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL SUPPOS 25 MG,1,17.39, 16.52 ,17.04, 16.52 , 16.87 , 16.52 ,Current Medicare Rates,16.87,16.69,Included in per diem,16.52,Included in ER Case rate,16.52,16.52, 17.04 ,15.651
Rx00904546061,RX,,00904546061,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-200 UNIT,1,5.86, 5.57 ,5.74, 5.57 , 5.68 , 5.57 ,Current Medicare Rates,5.68,5.63,Included in per diem,5.57,Included in ER Case rate,5.57,5.57, 5.74 ,5.274
Rx00904546092,RX,,00904546092,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM CARBONATE-CHOLECALCIFEROL TAB 500 MG-200 UNIT,1,5.75, 5.46 ,5.64, 5.46 , 5.58 , 5.46 ,Current Medicare Rates,5.58,5.52,Included in per diem,5.46,Included in ER Case rate,5.46,5.46, 5.64 ,5.175
Rx63739041510,RX,,63739041510,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIFAMPIN CAP 300 MG,1,7.08, 6.73 ,6.94, 6.73 , 6.87 , 6.73 ,Current Medicare Rates,6.87,6.8,Included in per diem,6.73,Included in ER Case rate,6.73,6.73, 6.94 ,6.372
Rx68084035801,RX,,68084035801,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIFAMPIN CAP 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084035811,RX,,68084035811,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIFAMPIN CAP 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904528261,RX,,00904528261,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIFAMPIN CAP 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084054111,RX,,68084054111,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAZOLAMIDE TAB 250 MG,1,15.82, 15.03 ,15.5, 15.03 , 15.35 , 15.03 ,Current Medicare Rates,15.35,15.19,Included in per diem,15.03,Included in ER Case rate,15.03,15.03, 15.50 ,14.238
Rx00904666361,RX,,00904666361,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAZOLAMIDE TAB 250 MG,1,20.02, 19.02 ,19.62, 19.02 , 19.42 , 19.02 ,Current Medicare Rates,19.42,19.22,Included in per diem,19.02,Included in ER Case rate,19.02,19.02, 19.62 ,18.018
Rx51672402301,RX,,51672402301,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAZOLAMIDE TAB 250 MG,1,17.74, 16.85 ,17.39, 16.85 , 17.21 , 16.85 ,Current Medicare Rates,17.21,17.03,Included in per diem,16.85,Included in ER Case rate,16.85,16.85, 17.39 ,15.966
Rx00904652261,RX,,00904652261,0250 - PHARMACY -  GENERAL CLASSIFICATION,SENNOSIDES TAB 8.6 MG,1,5.84, 5.55 ,5.72, 5.55 , 5.66 , 5.55 ,Current Medicare Rates,5.66,5.61,Included in per diem,5.55,Included in ER Case rate,5.55,5.55, 5.72 ,5.256
Rx57896045401,RX,,57896045401,0250 - PHARMACY -  GENERAL CLASSIFICATION,SENNOSIDES TAB 8.6 MG,1,5.74, 5.45 ,5.63, 5.45 , 5.57 , 5.45 ,Current Medicare Rates,5.57,5.51,Included in per diem,5.45,Included in ER Case rate,5.45,5.45, 5.63 ,5.166
Rx65862001301,RX,,65862001301,0250 - PHARMACY -  GENERAL CLASSIFICATION,SERTRALINE HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084018211,RX,,68084018211,0250 - PHARMACY -  GENERAL CLASSIFICATION,SERTRALINE HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687025311,RX,,60687025311,0250 - PHARMACY -  GENERAL CLASSIFICATION,SERTRALINE HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084018111,RX,,68084018111,0250 - PHARMACY -  GENERAL CLASSIFICATION,SERTRALINE HCL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687024211,RX,,60687024211,0250 - PHARMACY -  GENERAL CLASSIFICATION,SERTRALINE HCL TAB 50 MG,1,7.3, 6.94 ,7.15, 6.94 , 7.08 , 6.94 ,Current Medicare Rates,7.08,7.01,Included in per diem,6.94,Included in ER Case rate,6.94,6.94, 7.15 ,6.57
Rx00904692561,RX,,00904692561,0250 - PHARMACY -  GENERAL CLASSIFICATION,SERTRALINE HCL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739057110,RX,,63739057110,0250 - PHARMACY -  GENERAL CLASSIFICATION,SIMVASTATIN TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx16714068302,RX,,16714068302,0250 - PHARMACY -  GENERAL CLASSIFICATION,SIMVASTATIN TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739057210,RX,,63739057210,0250 - PHARMACY -  GENERAL CLASSIFICATION,SIMVASTATIN TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00121059515,RX,,00121059515,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CITRATE & CITRIC ACID SOLN 500-334 MG/5ML,1,65.7, 62.42 ,64.39, 62.42 , 63.73 , 62.42 ,Current Medicare Rates,63.73,63.07,Included in per diem,62.42,Included in ER Case rate,62.42,62.42, 64.39 ,59.13
Rx68084065401,RX,,68084065401,0250 - PHARMACY -  GENERAL CLASSIFICATION,SOTALOL HCL TAB 80 MG,1,11.41, 10.84 ,11.18, 10.84 , 11.07 , 10.84 ,Current Medicare Rates,11.07,10.95,Included in per diem,10.84,Included in ER Case rate,10.84,10.84, 11.18 ,10.269
Rx68084065411,RX,,68084065411,0250 - PHARMACY -  GENERAL CLASSIFICATION,SOTALOL HCL TAB 80 MG,1,7.14, 6.78 ,7, 6.78 , 6.93 , 6.78 ,Current Medicare Rates,6.93,6.85,Included in per diem,6.78,Included in ER Case rate,6.78,6.78, 7.00 ,6.426
Rx00093106101,RX,,00093106101,0250 - PHARMACY -  GENERAL CLASSIFICATION,SOTALOL HCL TAB 80 MG,1,6.59, 6.26 ,6.46, 6.26 , 6.39 , 6.26 ,Current Medicare Rates,6.39,6.33,Included in per diem,6.26,Included in ER Case rate,6.26,6.26, 6.46 ,5.931
Rx60687048701,RX,,60687048701,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE TAB 100 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx60687048711,RX,,60687048711,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE TAB 100 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx53489032901,RX,,53489032901,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE TAB 100 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00000001789,RX,,00000001789,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN-CODEINE #3 300-30 MG (ED HOMEPACK),1,6.15, 5.84 ,6.03, 5.84 , 5.97 , 5.84 ,Current Medicare Rates,5.97,5.9,Included in per diem,5.84,Included in ER Case rate,5.84,5.84, 6.03 ,5.535
Rx00487590199,RX,,00487590199,0250 - PHARMACY -  GENERAL CLASSIFICATION,RACEPINEPHRINE HCL SOLN NEBU 2.25% (BASE EQUIVALENT),1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00121074710,RX,,00121074710,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUCRALFATE SUSP 1 GM/10ML,1,31.1, 29.55 ,30.48, 29.55 , 30.17 , 29.55 ,Current Medicare Rates,30.17,29.86,Included in per diem,29.55,Included in ER Case rate,29.55,29.55, 30.48 ,27.99
Rx58914017014,RX,,58914017014,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUCRALFATE SUSP 1 GM/10ML,1,23.49, 22.32 ,23.02, 22.32 , 22.79 , 22.32 ,Current Medicare Rates,22.79,22.55,Included in per diem,22.32,Included in ER Case rate,22.32,22.32, 23.02 ,21.141
Rx66689079001,RX,,66689079001,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUCRALFATE SUSP 1 GM/10ML,1,40.13, 38.12 ,39.33, 38.12 , 38.93 , 38.12 ,Current Medicare Rates,38.93,38.52,Included in per diem,38.12,Included in ER Case rate,38.12,38.12, 39.33 ,36.117
Rx68094017159,RX,,68094017159,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUCRALFATE SUSP 1 GM/10ML,1,12.74, 12.10 ,12.49, 12.10 , 12.36 , 12.10 ,Current Medicare Rates,12.36,12.23,Included in per diem,12.1,Included in ER Case rate,12.1,12.1, 12.49 ,11.466
Rx68094004361,RX,,68094004361,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUCRALFATE SUSP 1 GM/10ML,1,35.59, 33.81 ,34.88, 33.81 , 34.52 , 33.81 ,Current Medicare Rates,34.52,34.17,Included in per diem,33.81,Included in ER Case rate,33.81,33.81, 34.88 ,32.031
Rx68094004359,RX,,68094004359,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUCRALFATE SUSP 1 GM/10ML,1,32.07, 30.47 ,31.43, 30.47 , 31.11 , 30.47 ,Current Medicare Rates,31.11,30.79,Included in per diem,30.47,Included in ER Case rate,30.47,30.47, 31.43 ,28.863
Rx00000004565,RX,,00000004565,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOFLOXACIN TAB 500 MG,1,14.65, 13.92 ,14.36, 13.92 , 14.21 , 13.92 ,Current Medicare Rates,14.21,14.06,Included in per diem,13.92,Included in ER Case rate,13.92,13.92, 14.36 ,13.185
Rx00527131801,RX,,00527131801,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERBUTALINE SULFATE TAB 2.5 MG,1,19.67, 18.69 ,19.28, 18.69 , 19.08 , 18.69 ,Current Medicare Rates,19.08,18.88,Included in per diem,18.69,Included in ER Case rate,18.69,18.69, 19.28 ,17.703
Rx62559072101,RX,,62559072101,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERBUTALINE SULFATE TAB 2.5 MG,1,18.75, 17.81 ,18.38, 17.81 , 18.19 , 17.81 ,Current Medicare Rates,18.19,18,Included in per diem,17.81,Included in ER Case rate,17.81,17.81, 18.38 ,16.875
Rx64980051305,RX,,64980051305,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIMOLOL MALEATE OPHTH SOLN 0.25%,1,23.48, 22.31 ,23.01, 22.31 , 22.78 , 22.31 ,Current Medicare Rates,22.78,22.54,Included in per diem,22.31,Included in ER Case rate,22.31,22.31, 23.01 ,21.132
Rx61314022605,RX,,61314022605,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIMOLOL MALEATE OPHTH SOLN 0.25%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx64980051405,RX,,64980051405,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIMOLOL MALEATE OPHTH SOLN 0.5%,1,41.52, 39.44 ,40.69, 39.44 , 40.27 , 39.44 ,Current Medicare Rates,40.27,39.86,Included in per diem,39.44,Included in ER Case rate,39.44,39.44, 40.69 ,37.368
Rx17478028810,RX,,17478028810,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIMOLOL MALEATE OPHTH SOLN 0.5%,1,30.08, 28.58 ,29.48, 28.58 , 29.18 , 28.58 ,Current Medicare Rates,29.18,28.88,Included in per diem,28.58,Included in ER Case rate,28.58,28.58, 29.48 ,27.072
Rx61314022705,RX,,61314022705,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIMOLOL MALEATE OPHTH SOLN 0.5%,1,28.78, 27.34 ,28.2, 27.34 , 27.92 , 27.34 ,Current Medicare Rates,27.92,27.63,Included in per diem,27.34,Included in ER Case rate,27.34,27.34, 28.20 ,25.902
Rx63739022810,RX,,63739022810,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904272561,RX,,00904272561,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM TAB 800-160 MG,1,6.31, 5.99 ,6.18, 5.99 , 6.12 , 5.99 ,Current Medicare Rates,6.12,6.06,Included in per diem,5.99,Included in ER Case rate,5.99,5.99, 6.18 ,5.679
Rx00904505960,RX,,00904505960,0250 - PHARMACY -  GENERAL CLASSIFICATION,WITCH HAZEL-GLYCERIN CLEANSING PADS,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx50289325001,RX,,50289325001,0250 - PHARMACY -  GENERAL CLASSIFICATION,WITCH HAZEL-GLYCERIN CLEANSING PADS,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00904608261,RX,,00904608261,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZOLPIDEM TARTRATE TAB 5 MG,1,6.46, 6.14 ,6.33, 6.14 , 6.27 , 6.14 ,Current Medicare Rates,6.27,6.2,Included in per diem,6.14,Included in ER Case rate,6.14,6.14, 6.33 ,5.814
Rx68084018911,RX,,68084018911,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZOLPIDEM TARTRATE TAB 5 MG,1,6.62, 6.29 ,6.49, 6.29 , 6.42 , 6.29 ,Current Medicare Rates,6.42,6.36,Included in per diem,6.29,Included in ER Case rate,6.29,6.29, 6.49 ,5.958
Rx00597002402,RX,,00597002402,0250 - PHARMACY -  GENERAL CLASSIFICATION,IPRATROPIUM-ALBUTEROL INHAL AEROSOL SOLN 20-100 MCG/ACT,1,1165.9," 1,107.61 ",1142.58," 1,107.61 "," 1,130.92 "," 1,107.61 ",Current Medicare Rates,1130.92,1119.26,Included in per diem,1107.61,Included in ER Case rate,1107.61,1107.61," 1,142.58 ",1049.31
Rx49100040007,RX,,49100040007,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTOBACILLUS RHAMNOSUS (GG) CAP,1,10.54, 10.01 ,10.33, 10.01 , 10.22 , 10.01 ,Current Medicare Rates,10.22,10.12,Included in per diem,10.01,Included in ER Case rate,10.01,10.01, 10.33 ,9.486
Rx49100038164,RX,,49100038164,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTOBACILLUS RHAMNOSUS (GG) CAP,1,10.19, 9.68 ,9.99, 9.68 , 9.88 , 9.68 ,Current Medicare Rates,9.88,9.78,Included in per diem,9.68,Included in ER Case rate,9.68,9.68, 9.99 ,9.171
Rx00406800330,RX,,00406800330,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00054040444,RX,,00054040444,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68094075401,RX,,68094075401,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68094004558,RX,,68094004558,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML),1,6.21, 5.90 ,6.09, 5.90 , 6.02 , 5.90 ,Current Medicare Rates,6.02,5.96,Included in per diem,5.9,Included in ER Case rate,5.9,5.9, 6.09 ,5.589
Rx68094004501,RX,,68094004501,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE ORAL SOLN 100 MG/5ML (20 MG/ML),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68084049011,RX,,68084049011,0250 - PHARMACY -  GENERAL CLASSIFICATION,MECLIZINE HCL TAB 12.5 MG,1,7.83, 7.44 ,7.67, 7.44 , 7.60 , 7.44 ,Current Medicare Rates,7.6,7.52,Included in per diem,7.44,Included in ER Case rate,7.44,7.44, 7.67 ,7.047
Rx51079042301,RX,,51079042301,0250 - PHARMACY -  GENERAL CLASSIFICATION,MECLIZINE HCL TAB 12.5 MG,1,8.02, 7.62 ,7.86, 7.62 , 7.78 , 7.62 ,Current Medicare Rates,7.78,7.7,Included in per diem,7.62,Included in ER Case rate,7.62,7.62, 7.86 ,7.218
Rx00904651661,RX,,00904651661,0250 - PHARMACY -  GENERAL CLASSIFICATION,MECLIZINE HCL TAB 12.5 MG,1,7.53, 7.15 ,7.38, 7.15 , 7.30 , 7.15 ,Current Medicare Rates,7.3,7.23,Included in per diem,7.15,Included in ER Case rate,7.15,7.15, 7.38 ,6.777
Rx00003089421,RX,,00003089421,0250 - PHARMACY -  GENERAL CLASSIFICATION,APIXABAN TAB 5 MG,1,6.76, 6.42 ,6.62, 6.42 , 6.56 , 6.42 ,Current Medicare Rates,6.56,6.49,Included in per diem,6.42,Included in ER Case rate,6.42,6.42, 6.62 ,6.084
Rx00003089431,RX,,00003089431,0250 - PHARMACY -  GENERAL CLASSIFICATION,APIXABAN TAB 5 MG,1,6.76, 6.42 ,6.62, 6.42 , 6.56 , 6.42 ,Current Medicare Rates,6.56,6.49,Included in per diem,6.42,Included in ER Case rate,6.42,6.42, 6.62 ,6.084
Rx51079048001,RX,,51079048001,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx16714031201,RX,,16714031201,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT),1,6.61, 6.28 ,6.48, 6.28 , 6.41 , 6.28 ,Current Medicare Rates,6.41,6.35,Included in per diem,6.28,Included in ER Case rate,6.28,6.28, 6.48 ,5.949
Rx68084084401,RX,,68084084401,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084084411,RX,,68084084411,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL TAB 37.5 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00406833023,RX,,00406833023,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE TAB ER 30 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00406831523,RX,,00406831523,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE TAB ER 15 MG,1,9.64, 9.16 ,9.45, 9.16 , 9.35 , 9.16 ,Current Medicare Rates,9.35,9.25,Included in per diem,9.16,Included in ER Case rate,9.16,9.16, 9.45 ,8.676
Rx00904655761,RX,,00904655761,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE TAB ER 15 MG,1,9.07, 8.62 ,8.89, 8.62 , 8.80 , 8.62 ,Current Medicare Rates,8.8,8.71,Included in per diem,8.62,Included in ER Case rate,8.62,8.62, 8.89 ,8.163
Rx17478006235,RX,,17478006235,0250 - PHARMACY -  GENERAL CLASSIFICATION,WHITE PETROLATUM-MINERAL OIL OPHTH OINTMENT,1,41.75, 39.66 ,40.92, 39.66 , 40.50 , 39.66 ,Current Medicare Rates,40.5,40.08,Included in per diem,39.66,Included in ER Case rate,39.66,39.66, 40.92 ,37.575
Rx69339015117,RX,,69339015117,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML,1,9.63, 9.15 ,9.44, 9.15 , 9.34 , 9.15 ,Current Medicare Rates,9.34,9.24,Included in per diem,9.15,Included in ER Case rate,9.15,9.15, 9.44 ,8.667
Rx69339015105,RX,,69339015105,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML,1,9.31, 8.84 ,9.12, 8.84 , 9.03 , 8.84 ,Current Medicare Rates,9.03,8.94,Included in per diem,8.84,Included in ER Case rate,8.84,8.84, 9.12 ,8.379
Rx67405054303,RX,,67405054303,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERBINAFINE HCL TAB 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51991052601,RX,,51991052601,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERBINAFINE HCL TAB 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx16714079501,RX,,16714079501,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERBINAFINE HCL TAB 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68462026001,RX,,68462026001,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 240 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx75834015901,RX,,75834015901,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 240 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079086901,RX,,51079086901,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 240 MG,1,6.68, 6.35 ,6.55, 6.35 , 6.48 , 6.35 ,Current Medicare Rates,6.48,6.41,Included in per diem,6.35,Included in ER Case rate,6.35,6.35, 6.55 ,6.012
Rx51079086920,RX,,51079086920,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 240 MG,1,16.26, 15.45 ,15.93, 15.45 , 15.77 , 15.45 ,Current Medicare Rates,15.77,15.61,Included in per diem,15.45,Included in ER Case rate,15.45,15.45, 15.93 ,14.634
Rx00904506260,RX,,00904506260,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM CITRATE TAB 950 MG (200 MG ELEMENTAL CA),1,5.81, 5.52 ,5.69, 5.52 , 5.64 , 5.52 ,Current Medicare Rates,5.64,5.58,Included in per diem,5.52,Included in ER Case rate,5.52,5.52, 5.69 ,5.229
Rx51079009301,RX,,51079009301,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALACYCLOVIR HCL TAB 500 MG,1,17.69, 16.81 ,17.34, 16.81 , 17.16 , 16.81 ,Current Medicare Rates,17.16,16.98,Included in per diem,16.81,Included in ER Case rate,16.81,16.81, 17.34 ,15.921
Rx63739052510,RX,,63739052510,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALACYCLOVIR HCL TAB 500 MG,1,22.52, 21.39 ,22.07, 21.39 , 21.84 , 21.39 ,Current Medicare Rates,21.84,21.62,Included in per diem,21.39,Included in ER Case rate,21.39,21.39, 22.07 ,20.268
Rx51079087001,RX,,51079087001,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMAZEPINE CHEW TAB 100 MG,1,7.5, 7.13 ,7.35, 7.13 , 7.28 , 7.13 ,Current Medicare Rates,7.28,7.2,Included in per diem,7.13,Included in ER Case rate,7.13,7.13, 7.35 ,6.75
Rx00904617261,RX,,00904617261,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMAZEPINE TAB 200 MG,1,8.77, 8.33 ,8.59, 8.33 , 8.51 , 8.33 ,Current Medicare Rates,8.51,8.42,Included in per diem,8.33,Included in ER Case rate,8.33,8.33, 8.59 ,7.893
Rx51079038501,RX,,51079038501,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMAZEPINE TAB 200 MG,1,7.7, 7.32 ,7.55, 7.32 , 7.47 , 7.32 ,Current Medicare Rates,7.47,7.39,Included in per diem,7.32,Included in ER Case rate,7.32,7.32, 7.55 ,6.93
Rx68462010340,RX,,68462010340,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUCONAZOLE TAB 150 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx16714069210,RX,,16714069210,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUCONAZOLE TAB 150 MG,1,6.98, 6.63 ,6.84, 6.63 , 6.77 , 6.63 ,Current Medicare Rates,6.77,6.7,Included in per diem,6.63,Included in ER Case rate,6.63,6.63, 6.84 ,6.282
Rx78112073623,RX,,78112073623,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMIDE PEROXIDE 6.5% OTIC SOLN,1,23.22, 22.06 ,22.76, 22.06 , 22.52 , 22.06 ,Current Medicare Rates,22.52,22.29,Included in per diem,22.06,Included in ER Case rate,22.06,22.06, 22.76 ,20.898
Rx49348096029,RX,,49348096029,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMIDE PEROXIDE 6.5% OTIC SOLN,1,23.41, 22.24 ,22.94, 22.24 , 22.71 , 22.24 ,Current Medicare Rates,22.71,22.47,Included in per diem,22.24,Included in ER Case rate,22.24,22.24, 22.94 ,21.069
Rx00904662735,RX,,00904662735,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMIDE PEROXIDE 6.5% OTIC SOLN,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00121174405,RX,,00121174405,0250 - PHARMACY -  GENERAL CLASSIFICATION,GUAIFENESIN LIQUID 100 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00603085794,RX,,00603085794,0250 - PHARMACY -  GENERAL CLASSIFICATION,GUAIFENESIN LIQUID 100 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50383006305,RX,,50383006305,0250 - PHARMACY -  GENERAL CLASSIFICATION,GUAIFENESIN LIQUID 100 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00168011109,RX,,00168011109,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN ZINC OINT 500 UNIT/GM,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx54162001709,RX,,54162001709,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN ZINC OINT 500 UNIT/GM,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx68084031801,RX,,68084031801,0250 - PHARMACY -  GENERAL CLASSIFICATION,LAMOTRIGINE TAB 25 MG,1,26.57, 25.24 ,26.04, 25.24 , 25.77 , 25.24 ,Current Medicare Rates,25.77,25.51,Included in per diem,25.24,Included in ER Case rate,25.24,25.24, 26.04 ,23.913
Rx68084031811,RX,,68084031811,0250 - PHARMACY -  GENERAL CLASSIFICATION,LAMOTRIGINE TAB 25 MG,1,25.89, 24.60 ,25.37, 24.60 , 25.11 , 24.60 ,Current Medicare Rates,25.11,24.85,Included in per diem,24.6,Included in ER Case rate,24.6,24.6, 25.37 ,23.301
Rx63739067010,RX,,63739067010,0250 - PHARMACY -  GENERAL CLASSIFICATION,LAMOTRIGINE TAB 25 MG,1,25.89, 24.60 ,25.37, 24.60 , 25.11 , 24.60 ,Current Medicare Rates,25.11,24.85,Included in per diem,24.6,Included in ER Case rate,24.6,24.6, 25.37 ,23.301
Rx68084031901,RX,,68084031901,0250 - PHARMACY -  GENERAL CLASSIFICATION,LAMOTRIGINE TAB 100 MG,1,6.67, 6.34 ,6.54, 6.34 , 6.47 , 6.34 ,Current Medicare Rates,6.47,6.4,Included in per diem,6.34,Included in ER Case rate,6.34,6.34, 6.54 ,6.003
Rx68084031911,RX,,68084031911,0250 - PHARMACY -  GENERAL CLASSIFICATION,LAMOTRIGINE TAB 100 MG,1,6.44, 6.12 ,6.31, 6.12 , 6.25 , 6.12 ,Current Medicare Rates,6.25,6.18,Included in per diem,6.12,Included in ER Case rate,6.12,6.12, 6.31 ,5.796
Rx63739000410,RX,,63739000410,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE TAB 300-30 MG,1,8.44, 8.02 ,8.27, 8.02 , 8.19 , 8.02 ,Current Medicare Rates,8.19,8.1,Included in per diem,8.02,Included in ER Case rate,8.02,8.02, 8.27 ,7.596
Rx68084037201,RX,,68084037201,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE TAB 300-30 MG,1,7.21, 6.85 ,7.07, 6.85 , 6.99 , 6.85 ,Current Medicare Rates,6.99,6.92,Included in per diem,6.85,Included in ER Case rate,6.85,6.85, 7.07 ,6.489
Rx51079016101,RX,,51079016101,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE TAB 300-30 MG,1,7.99, 7.59 ,7.83, 7.59 , 7.75 , 7.59 ,Current Medicare Rates,7.75,7.67,Included in per diem,7.59,Included in ER Case rate,7.59,7.59, 7.83 ,7.191
Rx00378609001,RX,,00378609001,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL CAP ER 12HR 90 MG,1,12.25, 11.64 ,12.01, 11.64 , 11.88 , 11.64 ,Current Medicare Rates,11.88,11.76,Included in per diem,11.64,Included in ER Case rate,11.64,11.64, 12.01 ,11.025
Rx51079092501,RX,,51079092501,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL CAP ER 12HR 90 MG,1,14.69, 13.96 ,14.4, 13.96 , 14.25 , 13.96 ,Current Medicare Rates,14.25,14.1,Included in per diem,13.96,Included in ER Case rate,13.96,13.96, 14.40 ,13.221
Rx51079092520,RX,,51079092520,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL CAP ER 12HR 90 MG,1,10.46, 9.94 ,10.25, 9.94 , 10.15 , 9.94 ,Current Medicare Rates,10.15,10.04,Included in per diem,9.94,Included in ER Case rate,9.94,9.94, 10.25 ,9.414
Rx63646001004,RX,,63646001004,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOCONAZOLE SHAMPOO 2%,1,83.98, 79.78 ,82.3, 79.78 , 81.46 , 79.78 ,Current Medicare Rates,81.46,80.62,Included in per diem,79.78,Included in ER Case rate,79.78,79.78, 82.30 ,75.582
Rx00472033956,RX,,00472033956,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE-ALOE VERA CREAM 1%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00536127780,RX,,00536127780,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE-ALOE VERA CREAM 1%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx49348044172,RX,,49348044172,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE-ALOE VERA CREAM 1%,1,18.73, 17.79 ,18.36, 17.79 , 18.17 , 17.79 ,Current Medicare Rates,18.17,17.98,Included in per diem,17.79,Included in ER Case rate,17.79,17.79, 18.36 ,16.857
Rx59011041020,RX,,59011041020,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB ER 12HR DETER 10 MG,1,16.88, 16.04 ,16.54, 16.04 , 16.37 , 16.04 ,Current Medicare Rates,16.37,16.2,Included in per diem,16.04,Included in ER Case rate,16.04,16.04, 16.54 ,15.192
Rx59011044020,RX,,59011044020,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB ER 12HR DETER 40 MG,1,12.75, 12.11 ,12.5, 12.11 , 12.37 , 12.11 ,Current Medicare Rates,12.37,12.24,Included in per diem,12.11,Included in ER Case rate,12.11,12.11, 12.50 ,11.475
Rx00121050404,RX,,00121050404,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00121050405,RX,,00121050405,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,1,13.59, 12.91 ,13.32, 12.91 , 13.18 , 12.91 ,Current Medicare Rates,13.18,13.05,Included in per diem,12.91,Included in ER Case rate,12.91,12.91, 13.32 ,12.231
Rx00121050416,RX,,00121050416,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00000003407,RX,,00000003407,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,1,34.76, 33.02 ,34.06, 33.02 , 33.72 , 33.02 ,Current Medicare Rates,33.72,33.37,Included in per diem,33.02,Included in ER Case rate,33.02,33.02, 34.06 ,31.284
Rx50383007905,RX,,50383007905,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,1,14.94, 14.19 ,14.64, 14.19 , 14.49 , 14.19 ,Current Medicare Rates,14.49,14.34,Included in per diem,14.19,Included in ER Case rate,14.19,14.19, 14.64 ,13.446
Rx59746038306,RX,,59746038306,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT),1,6.61, 6.28 ,6.48, 6.28 , 6.41 , 6.28 ,Current Medicare Rates,6.41,6.35,Included in per diem,6.28,Included in ER Case rate,6.28,6.28, 6.48 ,5.949
Rx00904612661,RX,,00904612661,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT),1,6.25, 5.94 ,6.13, 5.94 , 6.06 , 5.94 ,Current Medicare Rates,6.06,6,Included in per diem,5.94,Included in ER Case rate,5.94,5.94, 6.13 ,5.625
Rx00781205101,RX,,00781205101,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT),1,6.42, 6.10 ,6.29, 6.10 , 6.23 , 6.10 ,Current Medicare Rates,6.23,6.16,Included in per diem,6.1,Included in ER Case rate,6.1,6.1, 6.29 ,5.778
Rx51079093601,RX,,51079093601,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT),1,6.36, 6.04 ,6.23, 6.04 , 6.17 , 6.04 ,Current Medicare Rates,6.17,6.11,Included in per diem,6.04,Included in ER Case rate,6.04,6.04, 6.23 ,5.724
Rx51079093620,RX,,51079093620,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERAZOSIN HCL CAP 1 MG (BASE EQUIVALENT),1,6.35, 6.03 ,6.22, 6.03 , 6.16 , 6.03 ,Current Medicare Rates,6.16,6.1,Included in per diem,6.03,Included in ER Case rate,6.03,6.03, 6.22 ,5.715
Rx68462029301,RX,,68462029301,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 180 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687050401,RX,,60687050401,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 180 MG,1,5.72, 5.43 ,5.61, 5.43 , 5.55 , 5.43 ,Current Medicare Rates,5.55,5.49,Included in per diem,5.43,Included in ER Case rate,5.43,5.43, 5.61 ,5.148
Rx60687050411,RX,,60687050411,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 180 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079089901,RX,,51079089901,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB ER 180 MG,1,6.67, 6.34 ,6.54, 6.34 , 6.47 , 6.34 ,Current Medicare Rates,6.47,6.4,Included in per diem,6.34,Included in ER Case rate,6.34,6.34, 6.54 ,6.003
Rx00310196930,RX,,00310196930,0250 - PHARMACY -  GENERAL CLASSIFICATION,NALOXEGOL OXALATE TAB 12.5 MG (BASE EQUIVALENT),1,39.32, 37.35 ,38.53, 37.35 , 38.14 , 37.35 ,Current Medicare Rates,38.14,37.75,Included in per diem,37.35,Included in ER Case rate,37.35,37.35, 38.53 ,35.388
Rx57841130001,RX,,57841130001,0250 - PHARMACY -  GENERAL CLASSIFICATION,NALOXEGOL OXALATE TAB 12.5 MG (BASE EQUIVALENT),1,40.49, 38.47 ,39.68, 38.47 , 39.28 , 38.47 ,Current Medicare Rates,39.28,38.87,Included in per diem,38.47,Included in ER Case rate,38.47,38.47, 39.68 ,36.441
Rx51079099101,RX,,51079099101,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRAMADOL HCL TAB 50 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx63739067110,RX,,63739067110,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRAMADOL HCL TAB 50 MG,1,6.48, 6.16 ,6.35, 6.16 , 6.29 , 6.16 ,Current Medicare Rates,6.29,6.22,Included in per diem,6.16,Included in ER Case rate,6.16,6.16, 6.35 ,5.832
Rx60687014311,RX,,60687014311,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB 850 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093104901,RX,,00093104901,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB 850 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx55111017915,RX,,55111017915,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT),1,6.1, 5.80 ,5.98, 5.80 , 5.92 , 5.80 ,Current Medicare Rates,5.92,5.86,Included in per diem,5.8,Included in ER Case rate,5.8,5.8, 5.98 ,5.49
Rx68084077595,RX,,68084077595,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT),1,8.57, 8.14 ,8.4, 8.14 , 8.31 , 8.14 ,Current Medicare Rates,8.31,8.23,Included in per diem,8.14,Included in ER Case rate,8.14,8.14, 8.40 ,7.713
Rx50268075911,RX,,50268075911,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT),1,8.66, 8.23 ,8.49, 8.23 , 8.40 , 8.23 ,Current Medicare Rates,8.4,8.31,Included in per diem,8.23,Included in ER Case rate,8.23,8.23, 8.49 ,7.794
Rx50268075915,RX,,50268075915,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIZANIDINE HCL TAB 2 MG (BASE EQUIVALENT),1,8.66, 8.23 ,8.49, 8.23 , 8.40 , 8.23 ,Current Medicare Rates,8.4,8.31,Included in per diem,8.23,Included in ER Case rate,8.23,8.23, 8.49 ,7.794
Rx00904641861,RX,,00904641861,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIZANIDINE HCL TAB 4 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx10019055301,RX,,10019055301,0250 - PHARMACY -  GENERAL CLASSIFICATION,SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS,1,92.31, 87.69 ,90.46, 87.69 , 89.54 , 87.69 ,Current Medicare Rates,89.54,88.62,Included in per diem,87.69,Included in ER Case rate,87.69,87.69, 90.46 ,83.079
Rx10019055303,RX,,10019055303,0250 - PHARMACY -  GENERAL CLASSIFICATION,SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS,1,54.51, 51.78 ,53.42, 51.78 , 52.87 , 51.78 ,Current Medicare Rates,52.87,52.33,Included in per diem,51.78,Included in ER Case rate,51.78,51.78, 53.42 ,49.059
Rx10019055390,RX,,10019055390,0250 - PHARMACY -  GENERAL CLASSIFICATION,SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS,1,74.23, 70.52 ,72.75, 70.52 , 72.00 , 70.52 ,Current Medicare Rates,72,71.26,Included in per diem,70.52,Included in ER Case rate,70.52,70.52, 72.75 ,66.807
Rx00378647016,RX,,00378647016,0250 - PHARMACY -  GENERAL CLASSIFICATION,SCOPOLAMINE TD PATCH 72HR 1 MG/3DAYS,1,69.42, 65.95 ,68.03, 65.95 , 67.34 , 65.95 ,Current Medicare Rates,67.34,66.64,Included in per diem,65.95,Included in ER Case rate,65.95,65.95, 68.03 ,62.478
Rx68084034611,RX,,68084034611,0250 - PHARMACY -  GENERAL CLASSIFICATION,LOSARTAN POTASSIUM TAB 25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00904639161,RX,,00904639161,0250 - PHARMACY -  GENERAL CLASSIFICATION,LOSARTAN POTASSIUM TAB 25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00456430001,RX,,00456430001,0250 - PHARMACY -  GENERAL CLASSIFICATION,FOSFOMYCIN TROMETHAMINE POWD PACK 3 GM (BASE EQUIVALENT),1,234.07, 222.37 ,229.39, 222.37 , 227.05 , 222.37 ,Current Medicare Rates,227.05,224.71,Included in per diem,222.37,Included in ER Case rate,222.37,222.37, 229.39 ,210.663
Rx10119002090,RX,,10119002090,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAPHAZOLINE W/ PHENIRAMINE OPHTH SOLN 0.027-0.315%,1,28.85, 27.41 ,28.27, 27.41 , 27.98 , 27.41 ,Current Medicare Rates,27.98,27.7,Included in per diem,27.41,Included in ER Case rate,27.41,27.41, 28.27 ,25.965
Rx00536110145,RX,,00536110145,0250 - PHARMACY -  GENERAL CLASSIFICATION,MENTHOL-METHYL SALICYLATE CREAM,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx74300008186,RX,,74300008186,0250 - PHARMACY -  GENERAL CLASSIFICATION,MENTHOL-METHYL SALICYLATE CREAM,1,20.63, 19.60 ,20.22, 19.60 , 20.01 , 19.60 ,Current Medicare Rates,20.01,19.8,Included in per diem,19.6,Included in ER Case rate,19.6,19.6, 20.22 ,18.567
Rx74300000530,RX,,74300000530,0250 - PHARMACY -  GENERAL CLASSIFICATION,MENTHOL-METHYL SALICYLATE CREAM,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00536127505,RX,,00536127505,0250 - PHARMACY -  GENERAL CLASSIFICATION,SENNOSIDES SYRUP 8.8 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00536100059,RX,,00536100059,0250 - PHARMACY -  GENERAL CLASSIFICATION,SENNOSIDES SYRUP 8.8 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx48433021105,RX,,48433021105,0250 - PHARMACY -  GENERAL CLASSIFICATION,SENNOSIDES SYRUP 8.8 MG/5ML,1,11.78, 11.19 ,11.54, 11.19 , 11.43 , 11.19 ,Current Medicare Rates,11.43,11.31,Included in per diem,11.19,Included in ER Case rate,11.19,11.19, 11.54 ,10.602
Rx48433021940,RX,,48433021940,0250 - PHARMACY -  GENERAL CLASSIFICATION,SENNOSIDES SYRUP 8.8 MG/5ML,1,13.73, 13.04 ,13.46, 13.04 , 13.32 , 13.04 ,Current Medicare Rates,13.32,13.18,Included in per diem,13.04,Included in ER Case rate,13.04,13.04, 13.46 ,12.357
Rx48433021905,RX,,48433021905,0250 - PHARMACY -  GENERAL CLASSIFICATION,SENNOSIDES SYRUP 8.8 MG/5ML,1,13.73, 13.04 ,13.46, 13.04 , 13.32 , 13.04 ,Current Medicare Rates,13.32,13.18,Included in per diem,13.04,Included in ER Case rate,13.04,13.04, 13.46 ,12.357
Rx00799000103,RX,,00799000103,0250 - PHARMACY -  GENERAL CLASSIFICATION,MENTHOL-ZINC OXIDE OINT 0.44-20.6%,1,20.49, 19.47 ,20.08, 19.47 , 19.88 , 19.47 ,Current Medicare Rates,19.88,19.67,Included in per diem,19.47,Included in ER Case rate,19.47,19.47, 20.08 ,18.441
Rx62756052169,RX,,62756052169,0250 - PHARMACY -  GENERAL CLASSIFICATION,SUMATRIPTAN SUCCINATE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00395266216,RX,,00395266216,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHERRY SYRUP,1,52.61, 49.98 ,51.56, 49.98 , 51.03 , 49.98 ,Current Medicare Rates,51.03,50.51,Included in per diem,49.98,Included in ER Case rate,49.98,49.98, 51.56 ,47.349
Rx00781208102,RX,,00781208102,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA),1,7.68, 7.30 ,7.53, 7.30 , 7.45 , 7.30 ,Current Medicare Rates,7.45,7.37,Included in per diem,7.3,Included in ER Case rate,7.3,7.3, 7.53 ,6.912
Rx68094000261,RX,,68094000261,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCIUM ACETATE (PHOSPHATE BINDER) CAP 667 MG (169 MG CA),1,9.87, 9.38 ,9.67, 9.38 , 9.57 , 9.38 ,Current Medicare Rates,9.57,9.48,Included in per diem,9.38,Included in ER Case rate,9.38,9.38, 9.67 ,8.883
Rx60505082306,RX,,60505082306,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCITONIN (SALMON) NASAL SOLN 200 UNIT/ACT,1,249.36, 236.89 ,244.37, 236.89 , 241.88 , 236.89 ,Current Medicare Rates,241.88,239.39,Included in per diem,236.89,Included in ER Case rate,236.89,236.89, 244.37 ,224.424
Rx60429017701,RX,,60429017701,0250 - PHARMACY -  GENERAL CLASSIFICATION,BICALUTAMIDE TAB 50 MG,1,6.36, 6.04 ,6.23, 6.04 , 6.17 , 6.04 ,Current Medicare Rates,6.17,6.11,Included in per diem,6.04,Included in ER Case rate,6.04,6.04, 6.23 ,5.724
Rx00904630161,RX,,00904630161,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARVEDILOL TAB 6.25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084085411,RX,,68084085411,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARVEDILOL TAB 6.25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079093101,RX,,51079093101,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARVEDILOL TAB 12.5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904630261,RX,,00904630261,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARVEDILOL TAB 12.5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093202723,RX,,00093202723,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN FOR SUSP 100 MG/5ML,1,37.33, 35.46 ,36.58, 35.46 , 36.21 , 35.46 ,Current Medicare Rates,36.21,35.84,Included in per diem,35.46,Included in ER Case rate,35.46,35.46, 36.58 ,33.597
Rx59762313001,RX,,59762313001,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN FOR SUSP 200 MG/5ML,1,30.99, 29.44 ,30.37, 29.44 , 30.06 , 29.44 ,Current Medicare Rates,30.06,29.75,Included in per diem,29.44,Included in ER Case rate,29.44,29.44, 30.37 ,27.891
Rx00093202694,RX,,00093202694,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN FOR SUSP 200 MG/5ML,1,31.11, 29.55 ,30.49, 29.55 , 30.18 , 29.55 ,Current Medicare Rates,30.18,29.87,Included in per diem,29.55,Included in ER Case rate,29.55,29.55, 30.49 ,27.999
Rx00054004641,RX,,00054004641,0250 - PHARMACY -  GENERAL CLASSIFICATION,IPRATROPIUM BROMIDE NASAL SOLN 0.06% (42 MCG/SPRAY),1,88.78, 84.34 ,87, 84.34 , 86.12 , 84.34 ,Current Medicare Rates,86.12,85.23,Included in per diem,84.34,Included in ER Case rate,84.34,84.34, 87.00 ,79.902
Rx52747025003,RX,,52747025003,0250 - PHARMACY -  GENERAL CLASSIFICATION,HOMEOPATHIC PRODUCTS - VAG SUPP,1,25.76, 24.47 ,25.24, 24.47 , 24.99 , 24.47 ,Current Medicare Rates,24.99,24.73,Included in per diem,24.47,Included in ER Case rate,24.47,24.47, 25.24 ,23.184
Rx00555015902,RX,,00555015902,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORDIAZEPOXIDE HCL CAP 25 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079014101,RX,,51079014101,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORDIAZEPOXIDE HCL CAP 25 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00555015802,RX,,00555015802,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORDIAZEPOXIDE HCL CAP 5 MG,1,13.15, 12.49 ,12.89, 12.49 , 12.76 , 12.49 ,Current Medicare Rates,12.76,12.62,Included in per diem,12.49,Included in ER Case rate,12.49,12.49, 12.89 ,11.835
Rx51079037401,RX,,51079037401,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORDIAZEPOXIDE HCL CAP 5 MG,1,18.38, 17.46 ,18.01, 17.46 , 17.83 , 17.46 ,Current Medicare Rates,17.83,17.64,Included in per diem,17.46,Included in ER Case rate,17.46,17.46, 18.01 ,16.542
Rx51079042501,RX,,51079042501,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIMEPIRIDE TAB 2 MG,1,9.36, 8.89 ,9.17, 8.89 , 9.08 , 8.89 ,Current Medicare Rates,9.08,8.99,Included in per diem,8.89,Included in ER Case rate,8.89,8.89, 9.17 ,8.424
Rx68084032601,RX,,68084032601,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIMEPIRIDE TAB 2 MG,1,7.85, 7.46 ,7.69, 7.46 , 7.61 , 7.46 ,Current Medicare Rates,7.61,7.54,Included in per diem,7.46,Included in ER Case rate,7.46,7.46, 7.69 ,7.065
Rx68084032611,RX,,68084032611,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIMEPIRIDE TAB 2 MG,1,7.86, 7.47 ,7.7, 7.47 , 7.62 , 7.47 ,Current Medicare Rates,7.62,7.55,Included in per diem,7.47,Included in ER Case rate,7.47,7.47, 7.70 ,7.074
Rx50268035911,RX,,50268035911,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIMEPIRIDE TAB 2 MG,1,7.29, 6.93 ,7.14, 6.93 , 7.07 , 6.93 ,Current Medicare Rates,7.07,7,Included in per diem,6.93,Included in ER Case rate,6.93,6.93, 7.14 ,6.561
Rx50268035915,RX,,50268035915,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIMEPIRIDE TAB 2 MG,1,7.29, 6.93 ,7.14, 6.93 , 7.07 , 6.93 ,Current Medicare Rates,7.07,7,Included in per diem,6.93,Included in ER Case rate,6.93,6.93, 7.14 ,6.561
Rx51079005801,RX,,51079005801,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORTHALIDONE TAB 25 MG,1,9.06, 8.61 ,8.88, 8.61 , 8.79 , 8.61 ,Current Medicare Rates,8.79,8.7,Included in per diem,8.61,Included in ER Case rate,8.61,8.61, 8.88 ,8.154
Rx50268052415,RX,,50268052415,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 3 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904518206,RX,,00904518206,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 3 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904518261,RX,,00904518261,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 3 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx77333051610,RX,,77333051610,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 3 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx77333051625,RX,,77333051625,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 3 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx10006070031,RX,,10006070031,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 3 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00869066738,RX,,00869066738,0250 - PHARMACY -  GENERAL CLASSIFICATION,MAGNESIUM CITRATE SOLN,1,6.7, 6.37 ,6.57, 6.37 , 6.50 , 6.37 ,Current Medicare Rates,6.5,6.43,Included in per diem,6.37,Included in ER Case rate,6.37,6.37, 6.57 ,6.03
Rx00363013338,RX,,00363013338,0250 - PHARMACY -  GENERAL CLASSIFICATION,MAGNESIUM CITRATE SOLN,1,14.1, 13.40 ,13.82, 13.40 , 13.68 , 13.40 ,Current Medicare Rates,13.68,13.54,Included in per diem,13.4,Included in ER Case rate,13.4,13.4, 13.82 ,12.69
Rx70677005101,RX,,70677005101,0250 - PHARMACY -  GENERAL CLASSIFICATION,MAGNESIUM CITRATE SOLN,1,6.7, 6.37 ,6.57, 6.37 , 6.50 , 6.37 ,Current Medicare Rates,6.5,6.43,Included in per diem,6.37,Included in ER Case rate,6.37,6.37, 6.57 ,6.03
Rx59310030480,RX,,59310030480,0250 - PHARMACY -  GENERAL CLASSIFICATION,BECLOMETHASONE DIPROP HFA BREATH ACT INH AER 80 MCG/ACT,1,826.87, 785.53 ,810.33, 785.53 , 802.06 , 785.53 ,Current Medicare Rates,802.06,793.8,Included in per diem,785.53,Included in ER Case rate,785.53,785.53, 810.33 ,744.183
Rx63739005910,RX,,63739005910,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLINDAMYCIN HCL CAP 150 MG,1,6.72, 6.38 ,6.59, 6.38 , 6.52 , 6.38 ,Current Medicare Rates,6.52,6.45,Included in per diem,6.38,Included in ER Case rate,6.38,6.38, 6.59 ,6.048
Rx68084024301,RX,,68084024301,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLINDAMYCIN HCL CAP 150 MG,1,6.91, 6.56 ,6.77, 6.56 , 6.70 , 6.56 ,Current Medicare Rates,6.7,6.63,Included in per diem,6.56,Included in ER Case rate,6.56,6.56, 6.77 ,6.219
Rx68084024311,RX,,68084024311,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLINDAMYCIN HCL CAP 150 MG,1,6.87, 6.53 ,6.73, 6.53 , 6.66 , 6.53 ,Current Medicare Rates,6.66,6.6,Included in per diem,6.53,Included in ER Case rate,6.53,6.53, 6.73 ,6.183
Rx65628020510,RX,,65628020510,0250 - PHARMACY -  GENERAL CLASSIFICATION,VANCOMYCIN HCL FOR ORAL SOLN 25 MG/ML (BASE EQUIVALENT),1,39.51, 37.53 ,38.72, 37.53 , 38.32 , 37.53 ,Current Medicare Rates,38.32,37.93,Included in per diem,37.53,Included in ER Case rate,37.53,37.53, 38.72 ,35.559
Rx51079008601,RX,,51079008601,0250 - PHARMACY -  GENERAL CLASSIFICATION,MIRTAZAPINE TAB 15 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739035510,RX,,63739035510,0250 - PHARMACY -  GENERAL CLASSIFICATION,MIRTAZAPINE TAB 15 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079008620,RX,,51079008620,0250 - PHARMACY -  GENERAL CLASSIFICATION,MIRTAZAPINE TAB 15 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00228212710,RX,,00228212710,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE HCL TAB 0.1 MG,1,5.8, 5.51 ,5.68, 5.51 , 5.63 , 5.51 ,Current Medicare Rates,5.63,5.57,Included in per diem,5.51,Included in ER Case rate,5.51,5.51, 5.68 ,5.22
Rx63739006010,RX,,63739006010,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE HCL TAB 0.1 MG,1,6.06, 5.76 ,5.94, 5.76 , 5.88 , 5.76 ,Current Medicare Rates,5.88,5.82,Included in per diem,5.76,Included in ER Case rate,5.76,5.76, 5.94 ,5.454
Rx60687011301,RX,,60687011301,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE HCL TAB 0.1 MG,1,6.99, 6.64 ,6.85, 6.64 , 6.78 , 6.64 ,Current Medicare Rates,6.78,6.71,Included in per diem,6.64,Included in ER Case rate,6.64,6.64, 6.85 ,6.291
Rx60687011311,RX,,60687011311,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE HCL TAB 0.1 MG,1,6.83, 6.49 ,6.69, 6.49 , 6.63 , 6.49 ,Current Medicare Rates,6.63,6.56,Included in per diem,6.49,Included in ER Case rate,6.49,6.49, 6.69 ,6.147
Rx45802043411,RX,,45802043411,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLOTRIMAZOLE CREAM 1%,1,21.13, 20.07 ,20.71, 20.07 , 20.50 , 20.07 ,Current Medicare Rates,20.5,20.28,Included in per diem,20.07,Included in ER Case rate,20.07,20.07, 20.71 ,19.017
Rx00378087116,RX,,00378087116,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR,1,41.64, 39.56 ,40.81, 39.56 , 40.39 , 39.56 ,Current Medicare Rates,40.39,39.97,Included in per diem,39.56,Included in ER Case rate,39.56,39.56, 40.81 ,37.476
Rx00591350854,RX,,00591350854,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR,1,100.43, 95.41 ,98.42, 95.41 , 97.42 , 95.41 ,Current Medicare Rates,97.42,96.41,Included in per diem,95.41,Included in ER Case rate,95.41,95.41, 98.42 ,90.387
Rx51862045304,RX,,51862045304,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR,1,56.79, 53.95 ,55.65, 53.95 , 55.09 , 53.95 ,Current Medicare Rates,55.09,54.52,Included in per diem,53.95,Included in ER Case rate,53.95,53.95, 55.65 ,51.111
Rx51862045301,RX,,51862045301,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE TD PATCH WEEKLY 0.1 MG/24HR,1,56.97, 54.12 ,55.83, 54.12 , 55.26 , 54.12 ,Current Medicare Rates,55.26,54.69,Included in per diem,54.12,Included in ER Case rate,54.12,54.12, 55.83 ,51.273
Rx00173068220,RX,,00173068220,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV),1,143.42, 136.25 ,140.55, 136.25 , 139.12 , 136.25 ,Current Medicare Rates,139.12,137.68,Included in per diem,136.25,Included in ER Case rate,136.25,136.25, 140.55 ,129.078
Rx00173068224,RX,,00173068224,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE INHAL AERO 108 MCG/ACT (90MCG BASE EQUIV),1,69.79, 66.30 ,68.39, 66.30 , 67.70 , 66.30 ,Current Medicare Rates,67.7,67,Included in per diem,66.3,Included in ER Case rate,66.3,66.3, 68.39 ,62.811
Rx60687038911,RX,,60687038911,0250 - PHARMACY -  GENERAL CLASSIFICATION,COLCHICINE TAB 0.6 MG,1,23.65, 22.47 ,23.18, 22.47 , 22.94 , 22.47 ,Current Medicare Rates,22.94,22.7,Included in per diem,22.47,Included in ER Case rate,22.47,22.47, 23.18 ,21.285
Rx60687038921,RX,,60687038921,0250 - PHARMACY -  GENERAL CLASSIFICATION,COLCHICINE TAB 0.6 MG,1,24.44, 23.22 ,23.95, 23.22 , 23.71 , 23.22 ,Current Medicare Rates,23.71,23.46,Included in per diem,23.22,Included in ER Case rate,23.22,23.22, 23.95 ,21.996
Rx00904712004,RX,,00904712004,0250 - PHARMACY -  GENERAL CLASSIFICATION,COLCHICINE TAB 0.6 MG,1,15.33, 14.56 ,15.02, 14.56 , 14.87 , 14.56 ,Current Medicare Rates,14.87,14.72,Included in per diem,14.56,Included in ER Case rate,14.56,14.56, 15.02 ,13.797
Rx68084053911,RX,,68084053911,0250 - PHARMACY -  GENERAL CLASSIFICATION,TORSEMIDE TAB 20 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx60505011300,RX,,60505011300,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084076201,RX,,68084076201,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084076211,RX,,68084076211,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904666661,RX,,00904666661,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739067510,RX,,63739067510,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 100 MG,1,6.24, 5.93 ,6.12, 5.93 , 6.05 , 5.93 ,Current Medicare Rates,6.05,5.99,Included in per diem,5.93,Included in ER Case rate,5.93,5.93, 6.12 ,5.616
Rx68084078301,RX,,68084078301,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 100 MG,1,6.16, 5.85 ,6.04, 5.85 , 5.98 , 5.85 ,Current Medicare Rates,5.98,5.91,Included in per diem,5.85,Included in ER Case rate,5.85,5.85, 6.04 ,5.544
Rx68084078311,RX,,68084078311,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 100 MG,1,6.16, 5.85 ,6.04, 5.85 , 5.98 , 5.85 ,Current Medicare Rates,5.98,5.91,Included in per diem,5.85,Included in ER Case rate,5.85,5.85, 6.04 ,5.544
Rx63739059110,RX,,63739059110,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 100 MG,1,6.12, 5.81 ,6, 5.81 , 5.94 , 5.81 ,Current Medicare Rates,5.94,5.88,Included in per diem,5.81,Included in ER Case rate,5.81,5.81, 6.00 ,5.508
Rx00904666561,RX,,00904666561,0250 - PHARMACY -  GENERAL CLASSIFICATION,GABAPENTIN CAP 100 MG,1,6.12, 5.81 ,6, 5.81 , 5.94 , 5.81 ,Current Medicare Rates,5.94,5.88,Included in per diem,5.81,Included in ER Case rate,5.81,5.81, 6.00 ,5.508
Rx50458059210,RX,,50458059210,0250 - PHARMACY -  GENERAL CLASSIFICATION,RISPERIDONE TAB 1 MG,1,6.63, 6.30 ,6.5, 6.30 , 6.43 , 6.30 ,Current Medicare Rates,6.43,6.36,Included in per diem,6.3,Included in ER Case rate,6.3,6.3, 6.50 ,5.967
Rx00904635961,RX,,00904635961,0250 - PHARMACY -  GENERAL CLASSIFICATION,RISPERIDONE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079039201,RX,,51079039201,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPROPION HCL TAB ER 12HR 150 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904658561,RX,,00904658561,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPROPION HCL TAB ER 12HR 150 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904630061,RX,,00904630061,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARVEDILOL TAB 3.125 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx24208046325,RX,,24208046325,0250 - PHARMACY -  GENERAL CLASSIFICATION,LATANOPROST OPHTH SOLN 0.005%,1,360.27, 342.26 ,353.06, 342.26 , 349.46 , 342.26 ,Current Medicare Rates,349.46,345.86,Included in per diem,342.26,Included in ER Case rate,342.26,342.26, 353.06 ,324.243
Rx17478062512,RX,,17478062512,0250 - PHARMACY -  GENERAL CLASSIFICATION,LATANOPROST OPHTH SOLN 0.005%,1,346.3, 328.99 ,339.37, 328.99 , 335.91 , 328.99 ,Current Medicare Rates,335.91,332.45,Included in per diem,328.99,Included in ER Case rate,328.99,328.99, 339.37 ,311.67
Rx00904640861,RX,,00904640861,0250 - PHARMACY -  GENERAL CLASSIFICATION,DONEPEZIL HYDROCHLORIDE TAB 5 MG,1,6.29, 5.98 ,6.16, 5.98 , 6.10 , 5.98 ,Current Medicare Rates,6.1,6.04,Included in per diem,5.98,Included in ER Case rate,5.98,5.98, 6.16 ,5.661
Rx60687029211,RX,,60687029211,0250 - PHARMACY -  GENERAL CLASSIFICATION,DONEPEZIL HYDROCHLORIDE TAB 5 MG,1,6.37, 6.05 ,6.24, 6.05 , 6.18 , 6.05 ,Current Medicare Rates,6.18,6.12,Included in per diem,6.05,Included in ER Case rate,6.05,6.05, 6.24 ,5.733
Rx00904647761,RX,,00904647761,0250 - PHARMACY -  GENERAL CLASSIFICATION,DONEPEZIL HYDROCHLORIDE TAB 5 MG,1,6.19, 5.88 ,6.07, 5.88 , 6.00 , 5.88 ,Current Medicare Rates,6,5.94,Included in per diem,5.88,Included in ER Case rate,5.88,5.88, 6.07 ,5.571
Rx68084048111,RX,,68084048111,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOFLOXACIN TAB 250 MG,1,7.96, 7.56 ,7.8, 7.56 , 7.72 , 7.56 ,Current Medicare Rates,7.72,7.64,Included in per diem,7.56,Included in ER Case rate,7.56,7.56, 7.80 ,7.164
Rx00904635161,RX,,00904635161,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOFLOXACIN TAB 250 MG,1,6.51, 6.18 ,6.38, 6.18 , 6.31 , 6.18 ,Current Medicare Rates,6.31,6.25,Included in per diem,6.18,Included in ER Case rate,6.18,6.18, 6.38 ,5.859
Rx00904635261,RX,,00904635261,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOFLOXACIN TAB 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084034211,RX,,68084034211,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOPIRAMATE TAB 25 MG,1,6.73, 6.39 ,6.6, 6.39 , 6.53 , 6.39 ,Current Medicare Rates,6.53,6.46,Included in per diem,6.39,Included in ER Case rate,6.39,6.39, 6.60 ,6.057
Rx63481068447,RX,,63481068447,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICLOFENAC SODIUM GEL 1%,1,181.33, 172.26 ,177.7, 172.26 , 175.89 , 172.26 ,Current Medicare Rates,175.89,174.08,Included in per diem,172.26,Included in ER Case rate,172.26,172.26, 177.70 ,163.197
Rx65162083366,RX,,65162083366,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICLOFENAC SODIUM GEL 1%,1,85.74, 81.45 ,84.03, 81.45 , 83.17 , 81.45 ,Current Medicare Rates,83.17,82.31,Included in per diem,81.45,Included in ER Case rate,81.45,81.45, 84.03 ,77.166
Rx49884093547,RX,,49884093547,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICLOFENAC SODIUM GEL 1%,1,146.26, 138.95 ,143.33, 138.95 , 141.87 , 138.95 ,Current Medicare Rates,141.87,140.41,Included in per diem,138.95,Included in ER Case rate,138.95,138.95, 143.33 ,131.634
Rx45802016000,RX,,45802016000,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICLOFENAC SODIUM GEL 1%,1,164.8, 156.56 ,161.5, 156.56 , 159.86 , 156.56 ,Current Medicare Rates,159.86,158.21,Included in per diem,156.56,Included in ER Case rate,156.56,156.56, 161.50 ,148.32
Rx76282066339,RX,,76282066339,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICLOFENAC SODIUM GEL 1%,1,16.14, 15.33 ,15.82, 15.33 , 15.66 , 15.33 ,Current Medicare Rates,15.66,15.49,Included in per diem,15.33,Included in ER Case rate,15.33,15.33, 15.82 ,14.526
Rx00904629061,RX,,00904629061,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT),1,6.59, 6.26 ,6.46, 6.26 , 6.39 , 6.26 ,Current Medicare Rates,6.39,6.33,Included in per diem,6.26,Included in ER Case rate,6.26,6.26, 6.46 ,5.931
Rx51079020801,RX,,51079020801,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATORVASTATIN CALCIUM TAB 10 MG (BASE EQUIVALENT),1,7.29, 6.93 ,7.14, 6.93 , 7.07 , 6.93 ,Current Medicare Rates,7.07,7,Included in per diem,6.93,Included in ER Case rate,6.93,6.93, 7.14 ,6.561
Rx00904629161,RX,,00904629161,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079020901,RX,,51079020901,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATORVASTATIN CALCIUM TAB 20 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00574402135,RX,,00574402135,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN-POLYMYXIN B OPHTH OINT,1,83.5, 79.33 ,81.83, 79.33 , 81.00 , 79.33 ,Current Medicare Rates,81,80.16,Included in per diem,79.33,Included in ER Case rate,79.33,79.33, 81.83 ,75.15
Rx24208055555,RX,,24208055555,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN-POLYMYXIN B OPHTH OINT,1,86.89, 82.55 ,85.15, 82.55 , 84.28 , 82.55 ,Current Medicare Rates,84.28,83.41,Included in per diem,82.55,Included in ER Case rate,82.55,82.55, 85.15 ,78.201
Rx63736037882,RX,,63736037882,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZOCAINE AEROSOL 20%,1,23.98, 22.78 ,23.5, 22.78 , 23.26 , 22.78 ,Current Medicare Rates,23.26,23.02,Included in per diem,22.78,Included in ER Case rate,22.78,22.78, 23.50 ,21.582
Rx11701002214,RX,,11701002214,0250 - PHARMACY -  GENERAL CLASSIFICATION,UREA CREAM 10%,1,61.2, 58.14 ,59.98, 58.14 , 59.36 , 58.14 ,Current Medicare Rates,59.36,58.75,Included in per diem,58.14,Included in ER Case rate,58.14,58.14, 59.98 ,55.08
Rx00904421713,RX,,00904421713,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYANOCOBALAMIN TAB 1000 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx50268085511,RX,,50268085511,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYANOCOBALAMIN TAB 1000 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00591565801,RX,,00591565801,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOBENZAPRINE HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx69097084607,RX,,69097084607,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOBENZAPRINE HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079064401,RX,,51079064401,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOBENZAPRINE HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68180050101,RX,,68180050101,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELOXICAM TAB 7.5 MG,1,5.82, 5.53 ,5.7, 5.53 , 5.65 , 5.53 ,Current Medicare Rates,5.65,5.59,Included in per diem,5.53,Included in ER Case rate,5.53,5.53, 5.70 ,5.238
Rx50268052515,RX,,50268052515,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELOXICAM TAB 7.5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50268052511,RX,,50268052511,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELOXICAM TAB 7.5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx63739070110,RX,,63739070110,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELOXICAM TAB 7.5 MG,1,6.4, 6.08 ,6.27, 6.08 , 6.21 , 6.08 ,Current Medicare Rates,6.21,6.14,Included in per diem,6.08,Included in ER Case rate,6.08,6.08, 6.27 ,5.76
Rx00574012076,RX,,00574012076,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHARCOAL ACTIVATED-SORBITOL LIQ,1,76.75, 72.91 ,75.22, 72.91 , 74.45 , 72.91 ,Current Medicare Rates,74.45,73.68,Included in per diem,72.91,Included in ER Case rate,72.91,72.91, 75.22 ,69.075
Rx00574052076,RX,,00574052076,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHARCOAL ACTIVATED-SORBITOL LIQ,1,38.37, 36.45 ,37.6, 36.45 , 37.22 , 36.45 ,Current Medicare Rates,37.22,36.84,Included in per diem,36.45,Included in ER Case rate,36.45,36.45, 37.60 ,34.533
Rx59762306003,RX,,59762306003,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,17.42, 16.55 ,17.07, 16.55 , 16.90 , 16.55 ,Current Medicare Rates,16.9,16.72,Included in per diem,16.55,Included in ER Case rate,16.55,16.55, 17.07 ,15.678
Rx50268009811,RX,,50268009811,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,11.07, 10.52 ,10.85, 10.52 , 10.74 , 10.52 ,Current Medicare Rates,10.74,10.63,Included in per diem,10.52,Included in ER Case rate,10.52,10.52, 10.85 ,9.963
Rx00904640506,RX,,00904640506,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,11, 10.45 ,10.78, 10.45 , 10.67 , 10.45 ,Current Medicare Rates,10.67,10.56,Included in per diem,10.45,Included in ER Case rate,10.45,10.45, 10.78 ,9.9
Rx60687028201,RX,,60687028201,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,12.26, 11.65 ,12.01, 11.65 , 11.89 , 11.65 ,Current Medicare Rates,11.89,11.77,Included in per diem,11.65,Included in ER Case rate,11.65,11.65, 12.01 ,11.034
Rx60687028211,RX,,60687028211,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,11.88, 11.29 ,11.64, 11.29 , 11.52 , 11.29 ,Current Medicare Rates,11.52,11.4,Included in per diem,11.29,Included in ER Case rate,11.29,11.29, 11.64 ,10.692
Rx00781577606,RX,,00781577606,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,9.6, 9.12 ,9.41, 9.12 , 9.31 , 9.12 ,Current Medicare Rates,9.31,9.22,Included in per diem,9.12,Included in ER Case rate,9.12,9.12, 9.41 ,8.64
Rx50268007411,RX,,50268007411,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,9.82, 9.33 ,9.62, 9.33 , 9.53 , 9.33 ,Current Medicare Rates,9.53,9.43,Included in per diem,9.33,Included in ER Case rate,9.33,9.33, 9.62 ,8.838
Rx50268007413,RX,,50268007413,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN TAB 250 MG,1,9.05, 8.60 ,8.87, 8.60 , 8.78 , 8.60 ,Current Medicare Rates,8.78,8.69,Included in per diem,8.6,Included in ER Case rate,8.6,8.6, 8.87 ,8.145
Rx00093576701,RX,,00093576701,0250 - PHARMACY -  GENERAL CLASSIFICATION,OLANZAPINE TAB 2.5 MG,1,6.7, 6.37 ,6.57, 6.37 , 6.50 , 6.37 ,Current Medicare Rates,6.5,6.43,Included in per diem,6.37,Included in ER Case rate,6.37,6.37, 6.57 ,6.03
Rx00904628361,RX,,00904628361,0250 - PHARMACY -  GENERAL CLASSIFICATION,OLANZAPINE TAB 2.5 MG,1,6.21, 5.90 ,6.09, 5.90 , 6.02 , 5.90 ,Current Medicare Rates,6.02,5.96,Included in per diem,5.9,Included in ER Case rate,5.9,5.9, 6.09 ,5.589
Rx60505311000,RX,,60505311000,0250 - PHARMACY -  GENERAL CLASSIFICATION,OLANZAPINE TAB 2.5 MG,1,6.69, 6.36 ,6.56, 6.36 , 6.49 , 6.36 ,Current Medicare Rates,6.49,6.42,Included in per diem,6.36,Included in ER Case rate,6.36,6.36, 6.56 ,6.021
Rx00904608561,RX,,00904608561,0250 - PHARMACY -  GENERAL CLASSIFICATION,CITALOPRAM HYDROBROMIDE TAB 20 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx13668009290,RX,,13668009290,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68462033190,RX,,68462033190,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00904670461,RX,,00904670461,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAMIPEXOLE DIHYDROCHLORIDE TAB 0.25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00904544861,RX,,00904544861,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENTOXIFYLLINE TAB ER 400 MG,1,6.58, 6.25 ,6.45, 6.25 , 6.38 , 6.25 ,Current Medicare Rates,6.38,6.32,Included in per diem,6.25,Included in ER Case rate,6.25,6.25, 6.45 ,5.922
Rx51079088901,RX,,51079088901,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENTOXIFYLLINE TAB ER 400 MG,1,9.4, 8.93 ,9.21, 8.93 , 9.12 , 8.93 ,Current Medicare Rates,9.12,9.02,Included in per diem,8.93,Included in ER Case rate,8.93,8.93, 9.21 ,8.46
Rx60505003306,RX,,60505003306,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENTOXIFYLLINE TAB ER 400 MG,1,7.07, 6.72 ,6.93, 6.72 , 6.86 , 6.72 ,Current Medicare Rates,6.86,6.79,Included in per diem,6.72,Included in ER Case rate,6.72,6.72, 6.93 ,6.363
Rx00904637361,RX,,00904637361,0250 - PHARMACY -  GENERAL CLASSIFICATION,ROPINIROLE HYDROCHLORIDE TAB 0.25 MG,1,7.44, 7.07 ,7.29, 7.07 , 7.22 , 7.07 ,Current Medicare Rates,7.22,7.14,Included in per diem,7.07,Included in ER Case rate,7.07,7.07, 7.29 ,6.696
Rx68462025501,RX,,68462025501,0250 - PHARMACY -  GENERAL CLASSIFICATION,ROPINIROLE HYDROCHLORIDE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904637461,RX,,00904637461,0250 - PHARMACY -  GENERAL CLASSIFICATION,ROPINIROLE HYDROCHLORIDE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687058811,RX,,60687058811,0250 - PHARMACY -  GENERAL CLASSIFICATION,ROPINIROLE HYDROCHLORIDE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx41167000879,RX,,41167000879,0250 - PHARMACY -  GENERAL CLASSIFICATION,MENTHOL-METHYL SALICYLATE OINTMENT,1,24.02, 22.82 ,23.54, 22.82 , 23.30 , 22.82 ,Current Medicare Rates,23.3,23.06,Included in per diem,22.82,Included in ER Case rate,22.82,22.82, 23.54 ,21.618
Rx00904627761,RX,,00904627761,0250 - PHARMACY -  GENERAL CLASSIFICATION,QUETIAPINE FUMARATE TAB 25 MG,1,6.74, 6.40 ,6.61, 6.40 , 6.54 , 6.40 ,Current Medicare Rates,6.54,6.47,Included in per diem,6.4,Included in ER Case rate,6.4,6.4, 6.61 ,6.066
Rx00904663861,RX,,00904663861,0250 - PHARMACY -  GENERAL CLASSIFICATION,QUETIAPINE FUMARATE TAB 25 MG,1,6.37, 6.05 ,6.24, 6.05 , 6.18 , 6.05 ,Current Medicare Rates,6.18,6.12,Included in per diem,6.05,Included in ER Case rate,6.05,6.05, 6.24 ,5.733
Rx00904627961,RX,,00904627961,0250 - PHARMACY -  GENERAL CLASSIFICATION,QUETIAPINE FUMARATE TAB 100 MG,1,8, 7.60 ,7.84, 7.60 , 7.76 , 7.60 ,Current Medicare Rates,7.76,7.68,Included in per diem,7.6,Included in ER Case rate,7.6,7.6, 7.84 ,7.2
Rx63739066510,RX,,63739066510,0250 - PHARMACY -  GENERAL CLASSIFICATION,QUETIAPINE FUMARATE TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904664061,RX,,00904664061,0250 - PHARMACY -  GENERAL CLASSIFICATION,QUETIAPINE FUMARATE TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904629461,RX,,00904629461,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV),1,6.4, 6.08 ,6.27, 6.08 , 6.21 , 6.08 ,Current Medicare Rates,6.21,6.14,Included in per diem,6.08,Included in ER Case rate,6.08,6.08, 6.27 ,5.76
Rx68084053611,RX,,68084053611,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLOPIDOGREL BISULFATE TAB 75 MG (BASE EQUIV),1,7, 6.65 ,6.86, 6.65 , 6.79 , 6.65 ,Current Medicare Rates,6.79,6.72,Included in per diem,6.65,Included in ER Case rate,6.65,6.65, 6.86 ,6.3
Rx00009540001,RX,,00009540001,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE INHALER SYSTEM 10 MG (4 MG DELIVERED),1,169.95, 161.45 ,166.55, 161.45 , 164.85 , 161.45 ,Current Medicare Rates,164.85,163.15,Included in per diem,161.45,Included in ER Case rate,161.45,161.45, 166.55 ,152.955
Rx00009540006,RX,,00009540006,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE INHALER SYSTEM 10 MG (4 MG DELIVERED),1,169.95, 161.45 ,166.55, 161.45 , 164.85 , 161.45 ,Current Medicare Rates,164.85,163.15,Included in per diem,161.45,Included in ER Case rate,161.45,161.45, 166.55 ,152.955
Rx68462056417,RX,,68462056417,0250 - PHARMACY -  GENERAL CLASSIFICATION,MUPIROCIN CALCIUM CREAM 2%,1,529.18, 502.72 ,518.6, 502.72 , 513.30 , 502.72 ,Current Medicare Rates,513.3,508.01,Included in per diem,502.72,Included in ER Case rate,502.72,502.72, 518.60 ,476.262
Rx00781217660,RX,,00781217660,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFDINIR CAP 300 MG,1,10.03, 9.53 ,9.83, 9.53 , 9.73 , 9.53 ,Current Medicare Rates,9.73,9.63,Included in per diem,9.53,Included in ER Case rate,9.53,9.53, 9.83 ,9.027
Rx16714039102,RX,,16714039102,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFDINIR CAP 300 MG,1,10.05, 9.55 ,9.85, 9.55 , 9.75 , 9.55 ,Current Medicare Rates,9.75,9.65,Included in per diem,9.55,Included in ER Case rate,9.55,9.55, 9.85 ,9.045
Rx00781607761,RX,,00781607761,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFDINIR FOR SUSP 125 MG/5ML,1,11.49, 10.92 ,11.26, 10.92 , 11.15 , 10.92 ,Current Medicare Rates,11.15,11.03,Included in per diem,10.92,Included in ER Case rate,10.92,10.92, 11.26 ,10.341
Rx16714039201,RX,,16714039201,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFDINIR FOR SUSP 125 MG/5ML,1,13.34, 12.67 ,13.07, 12.67 , 12.94 , 12.67 ,Current Medicare Rates,12.94,12.81,Included in per diem,12.67,Included in ER Case rate,12.67,12.67, 13.07 ,12.006
Rx50268057511,RX,,50268057511,0250 - PHARMACY -  GENERAL CLASSIFICATION,MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV),1,7.33, 6.96 ,7.18, 6.96 , 7.11 , 6.96 ,Current Medicare Rates,7.11,7.04,Included in per diem,6.96,Included in ER Case rate,6.96,6.96, 7.18 ,6.597
Rx50268057515,RX,,50268057515,0250 - PHARMACY -  GENERAL CLASSIFICATION,MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV),1,7.84, 7.45 ,7.68, 7.45 , 7.60 , 7.45 ,Current Medicare Rates,7.6,7.53,Included in per diem,7.45,Included in ER Case rate,7.45,7.45, 7.68 ,7.056
Rx68084087501,RX,,68084087501,0250 - PHARMACY -  GENERAL CLASSIFICATION,MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV),1,7.69, 7.31 ,7.54, 7.31 , 7.46 , 7.31 ,Current Medicare Rates,7.46,7.38,Included in per diem,7.31,Included in ER Case rate,7.31,7.31, 7.54 ,6.921
Rx68084087511,RX,,68084087511,0250 - PHARMACY -  GENERAL CLASSIFICATION,MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV),1,7.44, 7.07 ,7.29, 7.07 , 7.22 , 7.07 ,Current Medicare Rates,7.22,7.14,Included in per diem,7.07,Included in ER Case rate,7.07,7.07, 7.29 ,6.696
Rx00904652961,RX,,00904652961,0250 - PHARMACY -  GENERAL CLASSIFICATION,MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV),1,7.05, 6.70 ,6.91, 6.70 , 6.84 , 6.70 ,Current Medicare Rates,6.84,6.77,Included in per diem,6.7,Included in ER Case rate,6.7,6.7, 6.91 ,6.345
Rx00904680861,RX,,00904680861,0250 - PHARMACY -  GENERAL CLASSIFICATION,MONTELUKAST SODIUM TAB 10 MG (BASE EQUIV),1,7.15, 6.79 ,7.01, 6.79 , 6.94 , 6.79 ,Current Medicare Rates,6.94,6.86,Included in per diem,6.79,Included in ER Case rate,6.79,6.79, 7.01 ,6.435
Rx65862049647,RX,,65862049647,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx17856049601,RX,,17856049601,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML,1,24.46, 23.24 ,23.97, 23.24 , 23.73 , 23.24 ,Current Medicare Rates,23.73,23.48,Included in per diem,23.24,Included in ER Case rate,23.24,23.24, 23.97 ,22.014
Rx00121085320,RX,,00121085320,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML,1,15.16, 14.40 ,14.86, 14.40 , 14.71 , 14.40 ,Current Medicare Rates,14.71,14.55,Included in per diem,14.4,Included in ER Case rate,14.4,14.4, 14.86 ,13.644
Rx50383082316,RX,,50383082316,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40 MG/5ML,1,9.91, 9.41 ,9.71, 9.41 , 9.61 , 9.41 ,Current Medicare Rates,9.61,9.51,Included in per diem,9.41,Included in ER Case rate,9.41,9.41, 9.71 ,8.919
Rx00065853110,RX,,00065853110,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN-HYDROCORTISONE OTIC SUSP 0.2-1%,1,976.9, 928.06 ,957.36, 928.06 , 947.59 , 928.06 ,Current Medicare Rates,947.59,937.82,Included in per diem,928.06,Included in ER Case rate,928.06,928.06, 957.36 ,879.21
Rx50419077701,RX,,50419077701,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN FOR ORAL SUSP 250 MG/5ML (5%) (5 GM/100ML),1,27.92, 26.52 ,27.36, 26.52 , 27.08 , 26.52 ,Current Medicare Rates,27.08,26.8,Included in per diem,26.52,Included in ER Case rate,26.52,26.52, 27.36 ,25.128
Rx00781187431,RX,,00781187431,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 250-125 MG,1,13.71, 13.02 ,13.44, 13.02 , 13.30 , 13.02 ,Current Medicare Rates,13.3,13.16,Included in per diem,13.02,Included in ER Case rate,13.02,13.02, 13.44 ,12.339
Rx16714029501,RX,,16714029501,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 250-125 MG,1,21.31, 20.24 ,20.88, 20.24 , 20.67 , 20.24 ,Current Medicare Rates,20.67,20.46,Included in per diem,20.24,Included in ER Case rate,20.24,20.24, 20.88 ,19.179
Rx16714047601,RX,,16714047601,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 250-125 MG,1,19.36, 18.39 ,18.97, 18.39 , 18.78 , 18.39 ,Current Medicare Rates,18.78,18.59,Included in per diem,18.39,Included in ER Case rate,18.39,18.39, 18.97 ,17.424
Rx24208072002,RX,,24208072002,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1%,1,159.07, 151.12 ,155.89, 151.12 , 154.30 , 151.12 ,Current Medicare Rates,154.3,152.71,Included in per diem,151.12,Included in ER Case rate,151.12,151.12, 155.89 ,143.163
Rx00172392660,RX,,00172392660,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIAZEPAM TAB 5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx63739007310,RX,,63739007310,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIAZEPAM TAB 5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00904588061,RX,,00904588061,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIAZEPAM TAB 5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079028501,RX,,51079028501,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIAZEPAM TAB 5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079028520,RX,,51079028520,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIAZEPAM TAB 5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00093312301,RX,,00093312301,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICLOXACILLIN SODIUM CAP 250 MG,1,7.67, 7.29 ,7.52, 7.29 , 7.44 , 7.29 ,Current Medicare Rates,7.44,7.36,Included in per diem,7.29,Included in ER Case rate,7.29,7.29, 7.52 ,6.903
Rx68094076459,RX,,68094076459,0250 - PHARMACY -  GENERAL CLASSIFICATION,MIDAZOLAM HCL SYRUP 2 MG/ML (BASE EQUIVALENT),1,12.76, 12.12 ,12.5, 12.12 , 12.38 , 12.12 ,Current Medicare Rates,12.38,12.25,Included in per diem,12.12,Included in ER Case rate,12.12,12.12, 12.50 ,11.484
Rx00527058601,RX,,00527058601,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICYCLOMINE HCL CAP 10 MG,1,6.71, 6.37 ,6.58, 6.37 , 6.51 , 6.37 ,Current Medicare Rates,6.51,6.44,Included in per diem,6.37,Included in ER Case rate,6.37,6.37, 6.58 ,6.039
Rx60687036901,RX,,60687036901,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICYCLOMINE HCL CAP 10 MG,1,8.54, 8.11 ,8.37, 8.11 , 8.28 , 8.11 ,Current Medicare Rates,8.28,8.2,Included in per diem,8.11,Included in ER Case rate,8.11,8.11, 8.37 ,7.686
Rx60687036911,RX,,60687036911,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICYCLOMINE HCL CAP 10 MG,1,7.82, 7.43 ,7.66, 7.43 , 7.59 , 7.43 ,Current Medicare Rates,7.59,7.51,Included in per diem,7.43,Included in ER Case rate,7.43,7.43, 7.66 ,7.038
Rx51079011801,RX,,51079011801,0250 - PHARMACY -  GENERAL CLASSIFICATION,DICYCLOMINE HCL CAP 10 MG,1,7.19, 6.83 ,7.05, 6.83 , 6.97 , 6.83 ,Current Medicare Rates,6.97,6.9,Included in per diem,6.83,Included in ER Case rate,6.83,6.83, 7.05 ,6.471
Rx57782039726,RX,,57782039726,0250 - PHARMACY -  GENERAL CLASSIFICATION,CROMOLYN SODIUM NASAL AEROSOL SOLN 5.2 MG/ACT (4%),1,169.95, 161.45 ,166.55, 161.45 , 164.85 , 161.45 ,Current Medicare Rates,164.85,163.15,Included in per diem,161.45,Included in ER Case rate,161.45,161.45, 166.55 ,152.955
Rx00904592161,RX,,00904592161,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 125 MCG (0.125 MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx24987024256,RX,,24987024256,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 125 MCG (0.125 MG),1,37.65, 35.77 ,36.9, 35.77 , 36.52 , 35.77 ,Current Medicare Rates,36.52,36.14,Included in per diem,35.77,Included in ER Case rate,35.77,35.77, 36.90 ,33.885
Rx00904592261,RX,,00904592261,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 250 MCG (0.25 MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx24987024956,RX,,24987024956,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 250 MCG (0.25 MG),1,6.5, 6.18 ,6.37, 6.18 , 6.31 , 6.18 ,Current Medicare Rates,6.31,6.24,Included in per diem,6.18,Included in ER Case rate,6.18,6.18, 6.37 ,5.85
Rx68084068001,RX,,68084068001,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 250 MCG (0.25 MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084068011,RX,,68084068011,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 250 MCG (0.25 MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42292000201,RX,,42292000201,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 250 MCG (0.25 MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42292000220,RX,,42292000220,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 250 MCG (0.25 MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx62175027037,RX,,62175027037,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG,1,9.54, 9.06 ,9.35, 9.06 , 9.25 , 9.06 ,Current Medicare Rates,9.25,9.16,Included in per diem,9.06,Included in ER Case rate,9.06,9.06, 9.35 ,8.586
Rx63739054833,RX,,63739054833,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG,1,17.7, 16.82 ,17.35, 16.82 , 17.17 , 16.82 ,Current Medicare Rates,17.17,16.99,Included in per diem,16.82,Included in ER Case rate,16.82,16.82, 17.35 ,15.93
Rx00904657006,RX,,00904657006,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYBUTYNIN CHLORIDE TAB ER 24HR 5 MG,1,12.64, 12.01 ,12.39, 12.01 , 12.26 , 12.01 ,Current Medicare Rates,12.26,12.13,Included in per diem,12.01,Included in ER Case rate,12.01,12.01, 12.39 ,11.376
Rx00185022360,RX,,00185022360,0250 - PHARMACY -  GENERAL CLASSIFICATION,CILOSTAZOL TAB 100 MG,1,8.84, 8.40 ,8.66, 8.40 , 8.57 , 8.40 ,Current Medicare Rates,8.57,8.49,Included in per diem,8.4,Included in ER Case rate,8.4,8.4, 8.66 ,7.956
Rx60505252201,RX,,60505252201,0250 - PHARMACY -  GENERAL CLASSIFICATION,CILOSTAZOL TAB 100 MG,1,6.73, 6.39 ,6.6, 6.39 , 6.53 , 6.39 ,Current Medicare Rates,6.53,6.46,Included in per diem,6.39,Included in ER Case rate,6.39,6.39, 6.60 ,6.057
Rx50268017711,RX,,50268017711,0250 - PHARMACY -  GENERAL CLASSIFICATION,CILOSTAZOL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904650261,RX,,00904650261,0250 - PHARMACY -  GENERAL CLASSIFICATION,CELECOXIB CAP 100 MG,1,9.31, 8.84 ,9.12, 8.84 , 9.03 , 8.84 ,Current Medicare Rates,9.03,8.94,Included in per diem,8.84,Included in ER Case rate,8.84,8.84, 9.12 ,8.379
Rx00025152034,RX,,00025152034,0250 - PHARMACY -  GENERAL CLASSIFICATION,CELECOXIB CAP 100 MG,1,30.3, 28.79 ,29.69, 28.79 , 29.39 , 28.79 ,Current Medicare Rates,29.39,29.09,Included in per diem,28.79,Included in ER Case rate,28.79,28.79, 29.69 ,27.27
Rx50268016811,RX,,50268016811,0250 - PHARMACY -  GENERAL CLASSIFICATION,CELECOXIB CAP 100 MG,1,9.78, 9.29 ,9.58, 9.29 , 9.49 , 9.29 ,Current Medicare Rates,9.49,9.39,Included in per diem,9.29,Included in ER Case rate,9.29,9.29, 9.58 ,8.802
Rx68084059111,RX,,68084059111,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE MONONITRATE TAB ER 24HR 30 MG,1,7.27, 6.91 ,7.12, 6.91 , 7.05 , 6.91 ,Current Medicare Rates,7.05,6.98,Included in per diem,6.91,Included in ER Case rate,6.91,6.91, 7.12 ,6.543
Rx63739008010,RX,,63739008010,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL TAB 60 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093031901,RX,,00093031901,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL TAB 60 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00143992701,RX,,00143992701,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV),1,6.42, 6.10 ,6.29, 6.10 , 6.23 , 6.10 ,Current Medicare Rates,6.23,6.16,Included in per diem,6.1,Included in ER Case rate,6.1,6.1, 6.29 ,5.778
Rx63739070010,RX,,63739070010,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL TAB 250 MG (BASE EQUIV),1,6.56, 6.23 ,6.43, 6.23 , 6.36 , 6.23 ,Current Medicare Rates,6.36,6.3,Included in per diem,6.23,Included in ER Case rate,6.23,6.23, 6.43 ,5.904
Rx68084007001,RX,,68084007001,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084007011,RX,,68084007011,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739055910,RX,,63739055910,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904637861,RX,,00904637861,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00472082516,RX,,00472082516,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE SYRUP 2 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx000930661RX,RX,,000930661RX,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE SYRUP 2 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx70752010212,RX,,70752010212,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE SYRUP 2 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00093066116,RX,,00093066116,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE SYRUP 2 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00143988701,RX,,00143988701,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00781615746,RX,,00781615746,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00781615752,RX,,00781615752,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx65862007150,RX,,65862007150,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00093416173,RX,,00093416173,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 400 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx47781060730,RX,,47781060730,0250 - PHARMACY -  GENERAL CLASSIFICATION,DISULFIRAM TAB 250 MG,1,7.04, 6.69 ,6.9, 6.69 , 6.83 , 6.69 ,Current Medicare Rates,6.83,6.76,Included in per diem,6.69,Included in ER Case rate,6.69,6.69, 6.90 ,6.336
Rx11523723401,RX,,11523723401,0250 - PHARMACY -  GENERAL CLASSIFICATION,POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM,1,9.29, 8.83 ,9.1, 8.83 , 9.01 , 8.83 ,Current Medicare Rates,9.01,8.92,Included in per diem,8.83,Included in ER Case rate,8.83,8.83, 9.10 ,8.361
Rx11523726808,RX,,11523726808,0250 - PHARMACY -  GENERAL CLASSIFICATION,POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM,1,6.8, 6.46 ,6.66, 6.46 , 6.60 , 6.46 ,Current Medicare Rates,6.6,6.53,Included in per diem,6.46,Included in ER Case rate,6.46,6.46, 6.66 ,6.12
Rx63739019861,RX,,63739019861,0250 - PHARMACY -  GENERAL CLASSIFICATION,POLYETHYLENE GLYCOL 3350 ORAL PACKET 17 GM,1,9.76, 9.27 ,9.56, 9.27 , 9.47 , 9.27 ,Current Medicare Rates,9.47,9.37,Included in per diem,9.27,Included in ER Case rate,9.27,9.27, 9.56 ,8.784
Rx00904635761,RX,,00904635761,0250 - PHARMACY -  GENERAL CLASSIFICATION,RISPERIDONE TAB 0.25 MG,1,6.4, 6.08 ,6.27, 6.08 , 6.21 , 6.08 ,Current Medicare Rates,6.21,6.14,Included in per diem,6.08,Included in ER Case rate,6.08,6.08, 6.27 ,5.76
Rx62756079788,RX,,62756079788,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00832712315,RX,,00832712315,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084077611,RX,,68084077611,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00832712389,RX,,00832712389,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739047810,RX,,63739047810,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOCUSATE SODIUM CAP 100 MG,1,5.83, 5.54 ,5.71, 5.54 , 5.66 , 5.54 ,Current Medicare Rates,5.66,5.6,Included in per diem,5.54,Included in ER Case rate,5.54,5.54, 5.71 ,5.247
Rx00904645561,RX,,00904645561,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOCUSATE SODIUM CAP 100 MG,1,5.81, 5.52 ,5.69, 5.52 , 5.64 , 5.52 ,Current Medicare Rates,5.64,5.58,Included in per diem,5.52,Included in ER Case rate,5.52,5.52, 5.69 ,5.229
Rx10135011101,RX,,10135011101,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOCUSATE SODIUM CAP 100 MG,1,5.78, 5.49 ,5.66, 5.49 , 5.61 , 5.49 ,Current Medicare Rates,5.61,5.55,Included in per diem,5.49,Included in ER Case rate,5.49,5.49, 5.66 ,5.202
Rx00904711561,RX,,00904711561,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOCUSATE SODIUM CAP 100 MG,1,5.81, 5.52 ,5.69, 5.52 , 5.64 , 5.52 ,Current Medicare Rates,5.64,5.58,Included in per diem,5.52,Included in ER Case rate,5.52,5.52, 5.69 ,5.229
Rx00536106401,RX,,00536106401,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOCUSATE SODIUM CAP 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx48433010101,RX,,48433010101,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOCUSATE SODIUM CAP 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42799080601,RX,,42799080601,0250 - PHARMACY -  GENERAL CLASSIFICATION,IVERMECTIN TAB 3 MG,1,18.71, 17.77 ,18.34, 17.77 , 18.15 , 17.77 ,Current Medicare Rates,18.15,17.96,Included in per diem,17.77,Included in ER Case rate,17.77,17.77, 18.34 ,16.839
Rx69238117009,RX,,69238117009,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXEPIN HCL CAP 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079043701,RX,,51079043701,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXEPIN HCL CAP 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687058501,RX,,60687058501,0250 - PHARMACY -  GENERAL CLASSIFICATION,PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV),1,6.71, 6.37 ,6.58, 6.37 , 6.51 , 6.37 ,Current Medicare Rates,6.51,6.44,Included in per diem,6.37,Included in ER Case rate,6.37,6.37, 6.58 ,6.039
Rx60687058511,RX,,60687058511,0250 - PHARMACY -  GENERAL CLASSIFICATION,PANTOPRAZOLE SODIUM EC TAB 20 MG (BASE EQUIV),1,6.71, 6.37 ,6.58, 6.37 , 6.51 , 6.37 ,Current Medicare Rates,6.51,6.44,Included in per diem,6.37,Included in ER Case rate,6.37,6.37, 6.58 ,6.039
Rx51079005101,RX,,51079005101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV),1,7.16, 6.80 ,7.02, 6.80 , 6.95 , 6.80 ,Current Medicare Rates,6.95,6.87,Included in per diem,6.8,Included in ER Case rate,6.8,6.8, 7.02 ,6.444
Rx63739056410,RX,,63739056410,0250 - PHARMACY -  GENERAL CLASSIFICATION,PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV),1,7.17, 6.81 ,7.03, 6.81 , 6.95 , 6.81 ,Current Medicare Rates,6.95,6.88,Included in per diem,6.81,Included in ER Case rate,6.81,6.81, 7.03 ,6.453
Rx35573042851,RX,,35573042851,0250 - PHARMACY -  GENERAL CLASSIFICATION,PANTOPRAZOLE SODIUM EC TAB 40 MG (BASE EQUIV),1,6.74, 6.40 ,6.61, 6.40 , 6.54 , 6.40 ,Current Medicare Rates,6.54,6.47,Included in per diem,6.4,Included in ER Case rate,6.4,6.4, 6.61 ,6.066
Rx62584069311,RX,,62584069311,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE TAB 100 MG,1,8.69, 8.26 ,8.52, 8.26 , 8.43 , 8.26 ,Current Medicare Rates,8.43,8.34,Included in per diem,8.26,Included in ER Case rate,8.26,8.26, 8.52 ,7.821
Rx62584069321,RX,,62584069321,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE TAB 100 MG,1,8.65, 8.22 ,8.48, 8.22 , 8.39 , 8.22 ,Current Medicare Rates,8.39,8.3,Included in per diem,8.22,Included in ER Case rate,8.22,8.22, 8.48 ,7.785
Rx00904043004,RX,,00904043004,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE TAB 100 MG,1,6.4, 6.08 ,6.27, 6.08 , 6.21 , 6.08 ,Current Medicare Rates,6.21,6.14,Included in per diem,6.08,Included in ER Case rate,6.08,6.08, 6.27 ,5.76
Rx00904043006,RX,,00904043006,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE TAB 100 MG,1,6.33, 6.01 ,6.2, 6.01 , 6.14 , 6.01 ,Current Medicare Rates,6.14,6.08,Included in per diem,6.01,Included in ER Case rate,6.01,6.01, 6.20 ,5.697
Rx53489012002,RX,,53489012002,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE TAB 100 MG,1,6.05, 5.75 ,5.93, 5.75 , 5.87 , 5.75 ,Current Medicare Rates,5.87,5.81,Included in per diem,5.75,Included in ER Case rate,5.75,5.75, 5.93 ,5.445
Rx62756045788,RX,,62756045788,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB ER 50-200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084028201,RX,,68084028201,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB ER 50-200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084028211,RX,,68084028211,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB ER 50-200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079092301,RX,,51079092301,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB ER 50-200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079092320,RX,,51079092320,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB ER 50-200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00004080085,RX,,00004080085,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV),1,21.67, 20.59 ,21.24, 20.59 , 21.02 , 20.59 ,Current Medicare Rates,21.02,20.8,Included in per diem,20.59,Included in ER Case rate,20.59,20.59, 21.24 ,19.503
Rx69238126601,RX,,69238126601,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV),1,12.37, 11.75 ,12.12, 11.75 , 12.00 , 11.75 ,Current Medicare Rates,12,11.88,Included in per diem,11.75,Included in ER Case rate,11.75,11.75, 12.12 ,11.133
Rx63739005007,RX,,63739005007,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV),1,16.36, 15.54 ,16.03, 15.54 , 15.87 , 15.54 ,Current Medicare Rates,15.87,15.71,Included in per diem,15.54,Included in ER Case rate,15.54,15.54, 16.03 ,14.724
Rx64380079901,RX,,64380079901,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE CAP 75 MG (BASE EQUIV),1,12.37, 11.75 ,12.12, 11.75 , 12.00 , 11.75 ,Current Medicare Rates,12,11.88,Included in per diem,11.75,Included in ER Case rate,11.75,11.75, 12.12 ,11.133
Rx00904605261,RX,,00904605261,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM TAB 500 MG,1,6.33, 6.01 ,6.2, 6.01 , 6.14 , 6.01 ,Current Medicare Rates,6.14,6.08,Included in per diem,6.01,Included in ER Case rate,6.01,6.01, 6.20 ,5.697
Rx68084087011,RX,,68084087011,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM TAB 500 MG,1,6.66, 6.33 ,6.53, 6.33 , 6.46 , 6.33 ,Current Medicare Rates,6.46,6.39,Included in per diem,6.33,Included in ER Case rate,6.33,6.33, 6.53 ,5.994
Rx51672208002,RX,,51672208002,0250 - PHARMACY -  GENERAL CLASSIFICATION,TERBINAFINE HCL CREAM 1%,1,40.74, 38.70 ,39.93, 38.70 , 39.52 , 38.70 ,Current Medicare Rates,39.52,39.11,Included in per diem,38.7,Included in ER Case rate,38.7,38.7, 39.93 ,36.666
Rx45802021001,RX,,45802021001,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TL SOLN 0.4 MG/SPRAY (400 MCG/SPRAY),1,578.5, 549.58 ,566.93, 549.58 , 561.15 , 549.58 ,Current Medicare Rates,561.15,555.36,Included in per diem,549.58,Included in ER Case rate,549.58,549.58, 566.93 ,520.65
Rx66689020108,RX,,66689020108,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHARCOAL ACTIVATED LIQ,1,57.84, 54.95 ,56.68, 54.95 , 56.10 , 54.95 ,Current Medicare Rates,56.1,55.53,Included in per diem,54.95,Included in ER Case rate,54.95,54.95, 56.68 ,52.056
Rx00574012108,RX,,00574012108,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHARCOAL ACTIVATED LIQ,1,37.82, 35.93 ,37.06, 35.93 , 36.69 , 35.93 ,Current Medicare Rates,36.69,36.31,Included in per diem,35.93,Included in ER Case rate,35.93,35.93, 37.06 ,34.038
Rx49348001875,RX,,49348001875,0250 - PHARMACY -  GENERAL CLASSIFICATION,MAGNESIUM SULFATE ORAL GRANULES,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,Included in per diem,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
Rx00121063805,RX,,00121063805,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML,1,8.92, 8.47 ,8.74, 8.47 , 8.65 , 8.47 ,Current Medicare Rates,8.65,8.56,Included in per diem,8.47,Included in ER Case rate,8.47,8.47, 8.74 ,8.028
Rx00378910493,RX,,00378910493,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00378910416,RX,,00378910416,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00904549546,RX,,00904549546,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx68382030901,RX,,68382030901,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.2 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00378911293,RX,,00378911293,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00904549646,RX,,00904549646,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00378911216,RX,,00378911216,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.4 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00378911616,RX,,00378911616,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx68382031101,RX,,68382031101,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx68382031130,RX,,68382031130,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN TD PATCH 24HR 0.6 MG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx51672412501,RX,,51672412501,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMAZEPINE TAB ER 12HR 400 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084056211,RX,,68084056211,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBAMAZEPINE TAB ER 12HR 400 MG,1,5.7, 5.42 ,5.59, 5.42 , 5.53 , 5.42 ,Current Medicare Rates,5.53,5.47,Included in per diem,5.42,Included in ER Case rate,5.42,5.42, 5.59 ,5.13
Rx00597000160,RX,,00597000160,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG,1,33.54, 31.86 ,32.87, 31.86 , 32.53 , 31.86 ,Current Medicare Rates,32.53,32.2,Included in per diem,31.86,Included in ER Case rate,31.86,31.86, 32.87 ,30.186
Rx65162059606,RX,,65162059606,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG,1,10.9, 10.36 ,10.68, 10.36 , 10.57 , 10.36 ,Current Medicare Rates,10.57,10.46,Included in per diem,10.36,Included in ER Case rate,10.36,10.36, 10.68 ,9.81
Rx60687030532,RX,,60687030532,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG,1,29.85, 28.36 ,29.25, 28.36 , 28.95 , 28.36 ,Current Medicare Rates,28.95,28.66,Included in per diem,28.36,Included in ER Case rate,28.36,28.36, 29.25 ,26.865
Rx60687030533,RX,,60687030533,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASPIRIN-DIPYRIDAMOLE CAP ER 12HR 25-200 MG,1,35.86, 34.07 ,35.14, 34.07 , 34.78 , 34.07 ,Current Medicare Rates,34.78,34.43,Included in per diem,34.07,Included in ER Case rate,34.07,34.07, 35.14 ,32.274
Rx62175026237,RX,,62175026237,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084060311,RX,,68084060311,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG,1,6.72, 6.38 ,6.59, 6.38 , 6.52 , 6.38 ,Current Medicare Rates,6.52,6.45,Included in per diem,6.38,Included in ER Case rate,6.38,6.38, 6.59 ,6.048
Rx50268059911,RX,,50268059911,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 90 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00225036011,RX,,00225036011,0250 - PHARMACY -  GENERAL CLASSIFICATION,TROLAMINE SALICYLATE CREAM 10%,1,28.73, 27.29 ,28.16, 27.29 , 27.87 , 27.29 ,Current Medicare Rates,27.87,27.58,Included in per diem,27.29,Included in ER Case rate,27.29,27.29, 28.16 ,25.857
Rx00904568461,RX,,00904568461,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEPRAZOLE CAP DELAYED RELEASE 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079000701,RX,,51079000701,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEPRAZOLE CAP DELAYED RELEASE 20 MG,1,6.59, 6.26 ,6.46, 6.26 , 6.39 , 6.26 ,Current Medicare Rates,6.39,6.33,Included in per diem,6.26,Included in ER Case rate,6.26,6.26, 6.46 ,5.931
Rx68084012811,RX,,68084012811,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEPRAZOLE CAP DELAYED RELEASE 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739035810,RX,,63739035810,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEPRAZOLE CAP DELAYED RELEASE 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60505006507,RX,,60505006507,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEPRAZOLE CAP DELAYED RELEASE 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904691761,RX,,00904691761,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEPRAZOLE CAP DELAYED RELEASE 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68462015713,RX,,68462015713,0250 - PHARMACY -  GENERAL CLASSIFICATION,ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00781523806,RX,,00781523806,0250 - PHARMACY -  GENERAL CLASSIFICATION,ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx68462015740,RX,,68462015740,0250 - PHARMACY -  GENERAL CLASSIFICATION,ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx65862039010,RX,,65862039010,0250 - PHARMACY -  GENERAL CLASSIFICATION,ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx57237007710,RX,,57237007710,0250 - PHARMACY -  GENERAL CLASSIFICATION,ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx59762018001,RX,,59762018001,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT),1,7.01, 6.66 ,6.87, 6.66 , 6.80 , 6.66 ,Current Medicare Rates,6.8,6.73,Included in per diem,6.66,Included in ER Case rate,6.66,6.66, 6.87 ,6.309
Rx68084069801,RX,,68084069801,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT),1,7.76, 7.37 ,7.6, 7.37 , 7.53 , 7.37 ,Current Medicare Rates,7.53,7.45,Included in per diem,7.37,Included in ER Case rate,7.37,7.37, 7.60 ,6.984
Rx68084069811,RX,,68084069811,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT),1,7.77, 7.38 ,7.61, 7.38 , 7.54 , 7.38 ,Current Medicare Rates,7.54,7.46,Included in per diem,7.38,Included in ER Case rate,7.38,7.38, 7.61 ,6.993
Rx00904646861,RX,,00904646861,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL CAP ER 24HR 37.5 MG (BASE EQUIVALENT),1,7.42, 7.05 ,7.27, 7.05 , 7.20 , 7.05 ,Current Medicare Rates,7.2,7.12,Included in per diem,7.05,Included in ER Case rate,7.05,7.05, 7.27 ,6.678
Rx68084070901,RX,,68084070901,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084070911,RX,,68084070911,0250 - PHARMACY -  GENERAL CLASSIFICATION,VENLAFAXINE HCL CAP ER 24HR 75 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00067512407,RX,,00067512407,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE TD PATCH 24HR 7 MG/24HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx43598044671,RX,,43598044671,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE TD PATCH 24HR 7 MG/24HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx60505706100,RX,,60505706100,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE TD PATCH 24HR 7 MG/24HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00067512507,RX,,00067512507,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE TD PATCH 24HR 14 MG/24HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx43598044771,RX,,43598044771,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE TD PATCH 24HR 14 MG/24HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00536589688,RX,,00536589688,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE TD PATCH 24HR 21 MG/24HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx43598044871,RX,,43598044871,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE TD PATCH 24HR 21 MG/24HR,1,15.7, 14.92 ,15.39, 14.92 , 15.23 , 14.92 ,Current Medicare Rates,15.23,15.07,Included in per diem,14.92,Included in ER Case rate,14.92,14.92, 15.39 ,14.13
Rx50383077515,RX,,50383077515,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE HCL VISCOUS SOLN 2%,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50383077517,RX,,50383077517,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE HCL VISCOUS SOLN 2%,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60505700602,RX,,60505700602,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 25 MCG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx60505708100,RX,,60505708100,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 25 MCG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx60505708102,RX,,60505708102,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 25 MCG/HR,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx60505700702,RX,,60505700702,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 50 MCG/HR,1,19.57, 18.59 ,19.18, 18.59 , 18.98 , 18.59 ,Current Medicare Rates,18.98,18.79,Included in per diem,18.59,Included in ER Case rate,18.59,18.59, 19.18 ,17.613
Rx60505708200,RX,,60505708200,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 50 MCG/HR,1,19.45, 18.48 ,19.06, 18.48 , 18.87 , 18.48 ,Current Medicare Rates,18.87,18.67,Included in per diem,18.48,Included in ER Case rate,18.48,18.48, 19.06 ,17.505
Rx60505708202,RX,,60505708202,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 50 MCG/HR,1,19.39, 18.42 ,19, 18.42 , 18.81 , 18.42 ,Current Medicare Rates,18.81,18.61,Included in per diem,18.42,Included in ER Case rate,18.42,18.42, 19.00 ,17.451
Rx00378912398,RX,,00378912398,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 75 MCG/HR,1,85.72, 81.43 ,84.01, 81.43 , 83.15 , 81.43 ,Current Medicare Rates,83.15,82.29,Included in per diem,81.43,Included in ER Case rate,81.43,81.43, 84.01 ,77.148
Rx00378912316,RX,,00378912316,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 75 MCG/HR,1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
Rx60505700800,RX,,60505700800,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 75 MCG/HR,1,28.52, 27.09 ,27.95, 27.09 , 27.66 , 27.09 ,Current Medicare Rates,27.66,27.38,Included in per diem,27.09,Included in ER Case rate,27.09,27.09, 27.95 ,25.668
Rx60505708300,RX,,60505708300,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 75 MCG/HR,1,28.38, 26.96 ,27.81, 26.96 , 27.53 , 26.96 ,Current Medicare Rates,27.53,27.24,Included in per diem,26.96,Included in ER Case rate,26.96,26.96, 27.81 ,25.542
Rx60505708302,RX,,60505708302,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 75 MCG/HR,1,28.29, 26.88 ,27.72, 26.88 , 27.44 , 26.88 ,Current Medicare Rates,27.44,27.16,Included in per diem,26.88,Included in ER Case rate,26.88,26.88, 27.72 ,25.461
Rx00536108494,RX,,00536108494,0250 - PHARMACY -  GENERAL CLASSIFICATION,POLYVINYL ALCOHOL OPHTH SOLN 1.4%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx17478006012,RX,,17478006012,0250 - PHARMACY -  GENERAL CLASSIFICATION,POLYVINYL ALCOHOL OPHTH SOLN 1.4%,1,35.38, 33.61 ,34.67, 33.61 , 34.32 , 33.61 ,Current Medicare Rates,34.32,33.96,Included in per diem,33.61,Included in ER Case rate,33.61,33.61, 34.67 ,31.842
Rx46287050816,RX,,46287050816,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINERAL OIL-HYDROPHILIC PETROLATUM OINTMENT,1,93.52, 88.84 ,91.65, 88.84 , 90.71 , 88.84 ,Current Medicare Rates,90.71,89.78,Included in per diem,88.84,Included in ER Case rate,88.84,88.84, 91.65 ,84.168
Rx46287000660,RX,,46287000660,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM POLYSTYRENE SULFONATE ORAL SUSP 15 GM/60ML,1,81.76, 77.67 ,80.12, 77.67 , 79.31 , 77.67 ,Current Medicare Rates,79.31,78.49,Included in per diem,77.67,Included in ER Case rate,77.67,77.67, 80.12 ,73.584
Rx16864068002,RX,,16864068002,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZOCAINE-MENTHOL AEROSOL 20-0.5%,1,19.45, 18.48 ,19.06, 18.48 , 18.87 , 18.48 ,Current Medicare Rates,18.87,18.67,Included in per diem,18.48,Included in ER Case rate,18.48,18.48, 19.06 ,17.505
Rx63029850401,RX,,63029850401,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZOCAINE-MENTHOL AEROSOL 20-0.5%,1,18.35, 17.43 ,17.98, 17.43 , 17.80 , 17.43 ,Current Medicare Rates,17.8,17.62,Included in per diem,17.43,Included in ER Case rate,17.43,17.43, 17.98 ,16.515
Rx49884032052,RX,,49884032052,0250 - PHARMACY -  GENERAL CLASSIFICATION,OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx49884032055,RX,,49884032055,0250 - PHARMACY -  GENERAL CLASSIFICATION,OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx55111026279,RX,,55111026279,0250 - PHARMACY -  GENERAL CLASSIFICATION,OLANZAPINE ORALLY DISINTEGRATING TAB 5 MG,1,11.31, 10.74 ,11.08, 10.74 , 10.97 , 10.74 ,Current Medicare Rates,10.97,10.86,Included in per diem,10.74,Included in ER Case rate,10.74,10.74, 11.08 ,10.179
Rx52380127204,RX,,52380127204,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORHEXIDINE GLUCONATE LIQUID 4%,1,31.17, 29.61 ,30.55, 29.61 , 30.23 , 29.61 ,Current Medicare Rates,30.23,29.92,Included in per diem,29.61,Included in ER Case rate,29.61,29.61, 30.55 ,28.053
Rx00234057532,RX,,00234057532,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORHEXIDINE GLUCONATE LIQUID 4%,1,61.38, 58.31 ,60.15, 58.31 , 59.54 , 58.31 ,Current Medicare Rates,59.54,58.92,Included in per diem,58.31,Included in ER Case rate,58.31,58.31, 60.15 ,55.242
Rx00603188010,RX,,00603188010,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE PATCH 5%,1,32.17, 30.56 ,31.53, 30.56 , 31.20 , 30.56 ,Current Medicare Rates,31.2,30.88,Included in per diem,30.56,Included in ER Case rate,30.56,30.56, 31.53 ,28.953
Rx00603188016,RX,,00603188016,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE PATCH 5%,1,32.06, 30.46 ,31.42, 30.46 , 31.10 , 30.46 ,Current Medicare Rates,31.1,30.78,Included in per diem,30.46,Included in ER Case rate,30.46,30.46, 31.42 ,28.854
Rx00378905593,RX,,00378905593,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE PATCH 5%,1,35.2, 33.44 ,34.5, 33.44 , 34.14 , 33.44 ,Current Medicare Rates,34.14,33.79,Included in per diem,33.44,Included in ER Case rate,33.44,33.44, 34.50 ,31.68
Rx00378905516,RX,,00378905516,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE PATCH 5%,1,35.31, 33.54 ,34.6, 33.54 , 34.25 , 33.54 ,Current Medicare Rates,34.25,33.9,Included in per diem,33.54,Included in ER Case rate,33.54,33.54, 34.60 ,31.779
Rx00904655304,RX,,00904655304,0250 - PHARMACY -  GENERAL CLASSIFICATION,LINEZOLID TAB 600 MG,1,16.74, 15.90 ,16.41, 15.90 , 16.24 , 15.90 ,Current Medicare Rates,16.24,16.07,Included in per diem,15.9,Included in ER Case rate,15.9,15.9, 16.41 ,15.066
Rx33342009009,RX,,33342009009,0250 - PHARMACY -  GENERAL CLASSIFICATION,RIVASTIGMINE TARTRATE CAP 3 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00406012523,RX,,00406012523,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN TAB 10-325 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079040001,RX,,51079040001,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG,1,10.01, 9.51 ,9.81, 9.51 , 9.71 , 9.51 ,Current Medicare Rates,9.71,9.61,Included in per diem,9.51,Included in ER Case rate,9.51,9.51, 9.81 ,9.009
Rx68084059711,RX,,68084059711,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE TAB ER 24HR OSMOTIC RELEASE 30 MG,1,9.7, 9.22 ,9.51, 9.22 , 9.41 , 9.22 ,Current Medicare Rates,9.41,9.31,Included in per diem,9.22,Included in ER Case rate,9.22,9.22, 9.51 ,8.73
Rx61314064511,RX,,61314064511,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%,1,259.49, 246.52 ,254.3, 246.52 , 251.71 , 246.52 ,Current Medicare Rates,251.71,249.11,Included in per diem,246.52,Included in ER Case rate,246.52,246.52, 254.30 ,233.541
Rx24208063562,RX,,24208063562,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-POLYMYXIN-HC OTIC SUSP 3.5 MG/ML-10000 UNIT/ML-1%,1,182.95, 173.80 ,179.29, 173.80 , 177.46 , 173.80 ,Current Medicare Rates,177.46,175.63,Included in per diem,173.8,Included in ER Case rate,173.8,173.8, 179.29 ,164.655
Rx64980032430,RX,,64980032430,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE PERIANAL CREAM 2.5%,1,85.09, 80.84 ,83.39, 80.84 , 82.54 , 80.84 ,Current Medicare Rates,82.54,81.69,Included in per diem,80.84,Included in ER Case rate,80.84,80.84, 83.39 ,76.581
Rx64980030130,RX,,64980030130,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE PERIANAL CREAM 2.5%,1,159.84, 151.85 ,156.64, 151.85 , 155.04 , 151.85 ,Current Medicare Rates,155.04,153.45,Included in per diem,151.85,Included in ER Case rate,151.85,151.85, 156.64 ,143.856
Rx00121043130,RX,,00121043130,0250 - PHARMACY -  GENERAL CLASSIFICATION,MAGNESIUM HYDROXIDE SUSP 400 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00574402411,RX,,00574402411,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERYTHROMYCIN OPHTH OINT 5 MG/GM,1,26.42, 25.10 ,25.89, 25.10 , 25.63 , 25.10 ,Current Medicare Rates,25.63,25.36,Included in per diem,25.1,Included in ER Case rate,25.1,25.1, 25.89 ,23.778
Rx24208091019,RX,,24208091019,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERYTHROMYCIN OPHTH OINT 5 MG/GM,1,28.62, 27.19 ,28.05, 27.19 , 27.76 , 27.19 ,Current Medicare Rates,27.76,27.48,Included in per diem,27.19,Included in ER Case rate,27.19,27.19, 28.05 ,25.758
Rx24208091055,RX,,24208091055,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERYTHROMYCIN OPHTH OINT 5 MG/GM,1,26.37, 25.05 ,25.84, 25.05 , 25.58 , 25.05 ,Current Medicare Rates,25.58,25.32,Included in per diem,25.05,Included in ER Case rate,25.05,25.05, 25.84 ,23.733
Rx51224000750,RX,,51224000750,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB ER 24HR 500 MG,1,6.12, 5.81 ,6, 5.81 , 5.94 , 5.81 ,Current Medicare Rates,5.94,5.88,Included in per diem,5.81,Included in ER Case rate,5.81,5.81, 6.00 ,5.508
Rx70010049109,RX,,70010049109,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB ER 24HR 500 MG,1,6.02, 5.72 ,5.9, 5.72 , 5.84 , 5.72 ,Current Medicare Rates,5.84,5.78,Included in per diem,5.72,Included in ER Case rate,5.72,5.72, 5.90 ,5.418
Rx24338013013,RX,,24338013013,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 400 MG/5ML,1,91.86, 87.27 ,90.02, 87.27 , 89.10 , 87.27 ,Current Medicare Rates,89.1,88.19,Included in per diem,87.27,Included in ER Case rate,87.27,87.27, 90.02 ,82.674
Rx62559063101,RX,,62559063101,0250 - PHARMACY -  GENERAL CLASSIFICATION,ERYTHROMYCIN ETHYLSUCCINATE FOR SUSP 400 MG/5ML,1,108.68, 103.25 ,106.51, 103.25 , 105.42 , 103.25 ,Current Medicare Rates,105.42,104.33,Included in per diem,103.25,Included in ER Case rate,103.25,103.25, 106.51 ,97.812
Rx16714063301,RX,,16714063301,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALENDRONATE SODIUM TAB 70 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687019501,RX,,60687019501,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG,1,7.36, 6.99 ,7.21, 6.99 , 7.14 , 6.99 ,Current Medicare Rates,7.14,7.07,Included in per diem,6.99,Included in ER Case rate,6.99,6.99, 7.21 ,6.624
Rx60687019511,RX,,60687019511,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG,1,7.36, 6.99 ,7.21, 6.99 , 7.14 , 6.99 ,Current Medicare Rates,7.14,7.07,Included in per diem,6.99,Included in ER Case rate,6.99,6.99, 7.21 ,6.624
Rx63739001410,RX,,63739001410,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL COATED BEADS CAP ER 24HR 120 MG,1,6.85, 6.51 ,6.71, 6.51 , 6.64 , 6.51 ,Current Medicare Rates,6.64,6.58,Included in per diem,6.51,Included in ER Case rate,6.51,6.51, 6.71 ,6.165
Rx63739028410,RX,,63739028410,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG,1,6.94, 6.59 ,6.8, 6.59 , 6.73 , 6.59 ,Current Medicare Rates,6.73,6.66,Included in per diem,6.59,Included in ER Case rate,6.59,6.59, 6.80 ,6.246
Rx60687020601,RX,,60687020601,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687020611,RX,,60687020611,0250 - PHARMACY -  GENERAL CLASSIFICATION,DILTIAZEM HCL COATED BEADS CAP ER 24HR 180 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx16714049601,RX,,16714049601,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%,1,84.19, 79.98 ,82.51, 79.98 , 81.66 , 79.98 ,Current Medicare Rates,81.66,80.82,Included in per diem,79.98,Included in ER Case rate,79.98,79.98, 82.51 ,75.771
Rx51672404801,RX,,51672404801,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLOTRIMAZOLE W/ BETAMETHASONE CREAM 1-0.05%,1,72.23, 68.62 ,70.79, 68.62 , 70.06 , 68.62 ,Current Medicare Rates,70.06,69.34,Included in per diem,68.62,Included in ER Case rate,68.62,68.62, 70.79 ,65.007
Rx00093204956,RX,,00093204956,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOLTERODINE TARTRATE CAP ER 24HR 4 MG,1,11.59, 11.01 ,11.36, 11.01 , 11.24 , 11.01 ,Current Medicare Rates,11.24,11.13,Included in per diem,11.01,Included in ER Case rate,11.01,11.01, 11.36 ,10.431
Rx51079019801,RX,,51079019801,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOLTERODINE TARTRATE CAP ER 24HR 4 MG,1,18.09, 17.19 ,17.73, 17.19 , 17.55 , 17.19 ,Current Medicare Rates,17.55,17.37,Included in per diem,17.19,Included in ER Case rate,17.19,17.19, 17.73 ,16.281
Rx59762004801,RX,,59762004801,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOLTERODINE TARTRATE CAP ER 24HR 4 MG,1,9.45, 8.98 ,9.26, 8.98 , 9.17 , 8.98 ,Current Medicare Rates,9.17,9.07,Included in per diem,8.98,Included in ER Case rate,8.98,8.98, 9.26 ,8.505
Rx59762004802,RX,,59762004802,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOLTERODINE TARTRATE CAP ER 24HR 4 MG,1,9.45, 8.98 ,9.26, 8.98 , 9.17 , 8.98 ,Current Medicare Rates,9.17,9.07,Included in per diem,8.98,Included in ER Case rate,8.98,8.98, 9.26 ,8.505
Rx00904659304,RX,,00904659304,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOLTERODINE TARTRATE CAP ER 24HR 4 MG,1,9.95, 9.45 ,9.75, 9.45 , 9.65 , 9.45 ,Current Medicare Rates,9.65,9.55,Included in per diem,9.45,Included in ER Case rate,9.45,9.45, 9.75 ,8.955
Rx60687033011,RX,,60687033011,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOLTERODINE TARTRATE CAP ER 24HR 4 MG,1,15.85, 15.06 ,15.53, 15.06 , 15.37 , 15.06 ,Current Medicare Rates,15.37,15.22,Included in per diem,15.06,Included in ER Case rate,15.06,15.06, 15.53 ,14.265
Rx00904632261,RX,,00904632261,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV),1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68084065901,RX,,68084065901,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV),1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68084065911,RX,,68084065911,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV),1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00904632206,RX,,00904632206,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL SUCCINATE TAB ER 24HR 25 MG (TARTRATE EQUIV),1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx59390017518,RX,,59390017518,0250 - PHARMACY -  GENERAL CLASSIFICATION,OPHTHALMIC IRRIGATION SOLUTION,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00904632361,RX,,00904632361,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV),1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68084066611,RX,,68084066611,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL SUCCINATE TAB ER 24HR 50 MG (TARTRATE EQUIV),1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx17518002301,RX,,17518002301,0250 - PHARMACY -  GENERAL CLASSIFICATION,PANTHENOL-GLYCERIN-DIMETHICONE CREAM,1,26.81, 25.47 ,26.27, 25.47 , 26.01 , 25.47 ,Current Medicare Rates,26.01,25.74,Included in per diem,25.47,Included in ER Case rate,25.47,25.47, 26.27 ,24.129
Rx00121053005,RX,,00121053005,0250 - PHARMACY -  GENERAL CLASSIFICATION,FERROUS SULFATE SYRUP 300 MG/5ML (60 MG/5ML ELEMENTAL FE),1,14.75, 14.01 ,14.46, 14.01 , 14.31 , 14.01 ,Current Medicare Rates,14.31,14.16,Included in per diem,14.01,Included in ER Case rate,14.01,14.01, 14.46 ,13.275
Rx39328015705,RX,,39328015705,0250 - PHARMACY -  GENERAL CLASSIFICATION,FERROUS SULFATE SYRUP 300 MG/5ML (60 MG/5ML ELEMENTAL FE),1,9.03, 8.58 ,8.85, 8.58 , 8.76 , 8.58 ,Current Medicare Rates,8.76,8.67,Included in per diem,8.58,Included in ER Case rate,8.58,8.58, 8.85 ,8.127
Rx00904759161,RX,,00904759161,0250 - PHARMACY -  GENERAL CLASSIFICATION,FERROUS SULFATE TAB 325 MG (65 MG ELEMENTAL FE),1,5.8, 5.51 ,5.68, 5.51 , 5.63 , 5.51 ,Current Medicare Rates,5.63,5.57,Included in per diem,5.51,Included in ER Case rate,5.51,5.51, 5.68 ,5.22
Rx63739041010,RX,,63739041010,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALLOPURINOL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079020501,RX,,51079020501,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALLOPURINOL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079020601,RX,,51079020601,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALLOPURINOL TAB 300 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx48433011001,RX,,48433011001,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEGA-3 FATTY ACIDS CAP 1000 MG,1,7.07, 6.72 ,6.93, 6.72 , 6.86 , 6.72 ,Current Medicare Rates,6.86,6.79,Included in per diem,6.72,Included in ER Case rate,6.72,6.72, 6.93 ,6.363
Rx77333030810,RX,,77333030810,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEGA-3 FATTY ACIDS CAP 1000 MG,1,6.51, 6.18 ,6.38, 6.18 , 6.31 , 6.18 ,Current Medicare Rates,6.31,6.25,Included in per diem,6.18,Included in ER Case rate,6.18,6.18, 6.38 ,5.859
Rx77333030825,RX,,77333030825,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEGA-3 FATTY ACIDS CAP 1000 MG,1,6.53, 6.20 ,6.4, 6.20 , 6.33 , 6.20 ,Current Medicare Rates,6.33,6.27,Included in per diem,6.2,Included in ER Case rate,6.2,6.2, 6.40 ,5.877
Rx12462020104,RX,,12462020104,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM PHOSPHATES - ENEMA,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx13925011701,RX,,13925011701,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRENATAL VIT W/ FE FUMARATE-FA CHEW TAB 29-1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx60258019701,RX,,60258019701,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRENATAL VIT W/ FE FUMARATE-FA CHEW TAB 29-1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx62584089701,RX,,62584089701,0250 - PHARMACY -  GENERAL CLASSIFICATION,FOLIC ACID TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx62584089711,RX,,62584089711,0250 - PHARMACY -  GENERAL CLASSIFICATION,FOLIC ACID TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739053710,RX,,63739053710,0250 - PHARMACY -  GENERAL CLASSIFICATION,FOLIC ACID TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68094075659,RX,,68094075659,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE ORAL SOLN 10 MG/ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00054829725,RX,,00054829725,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079007201,RX,,51079007201,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00054829925,RX,,00054829925,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 40 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079007301,RX,,51079007301,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 40 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00054830125,RX,,00054830125,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 80 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079052701,RX,,51079052701,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 80 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079052720,RX,,51079052720,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 80 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx16714029601,RX,,16714029601,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 500-125 MG,1,18.51, 17.58 ,18.14, 17.58 , 17.95 , 17.58 ,Current Medicare Rates,17.95,17.77,Included in per diem,17.58,Included in ER Case rate,17.58,17.58, 18.14 ,16.659
Rx00781183120,RX,,00781183120,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 500-125 MG,1,10.63, 10.10 ,10.42, 10.10 , 10.31 , 10.10 ,Current Medicare Rates,10.31,10.2,Included in per diem,10.1,Included in ER Case rate,10.1,10.1, 10.42 ,9.567
Rx16714049401,RX,,16714049401,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 500-125 MG,1,11.85, 11.26 ,11.61, 11.26 , 11.49 , 11.26 ,Current Medicare Rates,11.49,11.38,Included in per diem,11.26,Included in ER Case rate,11.26,11.26, 11.61 ,10.665
Rx16714029701,RX,,16714029701,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 875-125 MG,1,7.4, 7.03 ,7.25, 7.03 , 7.18 , 7.03 ,Current Medicare Rates,7.18,7.1,Included in per diem,7.03,Included in ER Case rate,7.03,7.03, 7.25 ,6.66
Rx16714047801,RX,,16714047801,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 875-125 MG,1,14.73, 13.99 ,14.44, 13.99 , 14.29 , 13.99 ,Current Medicare Rates,14.29,14.14,Included in per diem,13.99,Included in ER Case rate,13.99,13.99, 14.44 ,13.257
Rx16714001401,RX,,16714001401,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE TAB 875-125 MG,1,8.19, 7.78 ,8.03, 7.78 , 7.94 , 7.78 ,Current Medicare Rates,7.94,7.86,Included in per diem,7.78,Included in ER Case rate,7.78,7.78, 8.03 ,7.371
Rx65862053401,RX,,65862053401,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx16714029303,RX,,16714029303,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00781610446,RX,,00781610446,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 400-57 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00904642661,RX,,00904642661,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESCITALOPRAM OXALATE TAB 10 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00078042315,RX,,00078042315,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALSARTAN TAB 40 MG,1,23.44, 22.27 ,22.97, 22.27 , 22.74 , 22.27 ,Current Medicare Rates,22.74,22.5,Included in per diem,22.27,Included in ER Case rate,22.27,22.27, 22.97 ,21.096
Rx00378580793,RX,,00378580793,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALSARTAN TAB 40 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx59746036030,RX,,59746036030,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALSARTAN TAB 40 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx43547036703,RX,,43547036703,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALSARTAN TAB 40 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx33342006207,RX,,33342006207,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALSARTAN TAB 40 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687061211,RX,,60687061211,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALSARTAN TAB 40 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084013521,RX,,68084013521,0250 - PHARMACY -  GENERAL CLASSIFICATION,METAXALONE TAB 800 MG,1,9.99, 9.49 ,9.79, 9.49 , 9.69 , 9.49 ,Current Medicare Rates,9.69,9.59,Included in per diem,9.49,Included in ER Case rate,9.49,9.49, 9.79 ,8.991
Rx68084013511,RX,,68084013511,0250 - PHARMACY -  GENERAL CLASSIFICATION,METAXALONE TAB 800 MG,1,9.71, 9.22 ,9.52, 9.22 , 9.42 , 9.22 ,Current Medicare Rates,9.42,9.32,Included in per diem,9.22,Included in ER Case rate,9.22,9.22, 9.52 ,8.739
Rx50268053011,RX,,50268053011,0250 - PHARMACY -  GENERAL CLASSIFICATION,METAXALONE TAB 800 MG,1,11.41, 10.84 ,11.18, 10.84 , 11.07 , 10.84 ,Current Medicare Rates,11.07,10.95,Included in per diem,10.84,Included in ER Case rate,10.84,10.84, 11.18 ,10.269
Rx00173071215,RX,,00173071215,0250 - PHARMACY -  GENERAL CLASSIFICATION,DUTASTERIDE CAP 0.5 MG,1,27.1, 25.75 ,26.56, 25.75 , 26.29 , 25.75 ,Current Medicare Rates,26.29,26.02,Included in per diem,25.75,Included in ER Case rate,25.75,25.75, 26.56 ,24.39
Rx31722013130,RX,,31722013130,0250 - PHARMACY -  GENERAL CLASSIFICATION,DUTASTERIDE CAP 0.5 MG,1,6.66, 6.33 ,6.53, 6.33 , 6.46 , 6.33 ,Current Medicare Rates,6.46,6.39,Included in per diem,6.33,Included in ER Case rate,6.33,6.33, 6.53 ,5.994
Rx60687028411,RX,,60687028411,0250 - PHARMACY -  GENERAL CLASSIFICATION,EZETIMIBE TAB 10 MG,1,35.39, 33.62 ,34.68, 33.62 , 34.33 , 33.62 ,Current Medicare Rates,34.33,33.97,Included in per diem,33.62,Included in ER Case rate,33.62,33.62, 34.68 ,31.851
Rx00904666404,RX,,00904666404,0250 - PHARMACY -  GENERAL CLASSIFICATION,EZETIMIBE TAB 10 MG,1,22.78, 21.64 ,22.32, 21.64 , 22.10 , 21.64 ,Current Medicare Rates,22.1,21.87,Included in per diem,21.64,Included in ER Case rate,21.64,21.64, 22.32 ,20.502
Rx66582041431,RX,,66582041431,0250 - PHARMACY -  GENERAL CLASSIFICATION,EZETIMIBE TAB 10 MG,1,41, 38.95 ,40.18, 38.95 , 39.77 , 38.95 ,Current Medicare Rates,39.77,39.36,Included in per diem,38.95,Included in ER Case rate,38.95,38.95, 40.18 ,36.9
Rx51079076601,RX,,51079076601,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB ER 24 HR 250 MG,1,23.8, 22.61 ,23.32, 22.61 , 23.09 , 22.61 ,Current Medicare Rates,23.09,22.85,Included in per diem,22.61,Included in ER Case rate,22.61,22.61, 23.32 ,21.42
Rx51079076608,RX,,51079076608,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB ER 24 HR 250 MG,1,26.73, 25.39 ,26.2, 25.39 , 25.93 , 25.39 ,Current Medicare Rates,25.93,25.66,Included in per diem,25.39,Included in ER Case rate,25.39,25.39, 26.20 ,24.057
Rx00904636345,RX,,00904636345,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB ER 24 HR 250 MG,1,23.96, 22.76 ,23.48, 22.76 , 23.24 , 22.76 ,Current Medicare Rates,23.24,23,Included in per diem,22.76,Included in ER Case rate,22.76,22.76, 23.48 ,21.564
Rx00904636361,RX,,00904636361,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB ER 24 HR 250 MG,1,19.39, 18.42 ,19, 18.42 , 18.81 , 18.42 ,Current Medicare Rates,18.81,18.61,Included in per diem,18.42,Included in ER Case rate,18.42,18.42, 19.00 ,17.451
Rx00406012323,RX,,00406012323,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN TAB 5-325 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00406012423,RX,,00406012423,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00054017713,RX,,00054017713,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV),1,10.66, 10.13 ,10.45, 10.13 , 10.34 , 10.13 ,Current Medicare Rates,10.34,10.23,Included in per diem,10.13,Included in ER Case rate,10.13,10.13, 10.45 ,9.594
Rx42858050203,RX,,42858050203,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL SL TAB 8 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx65162041603,RX,,65162041603,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL-NALOXONE HCL SL TAB 2-0.5 MG (BASE EQUIV),1,11.48, 10.91 ,11.25, 10.91 , 11.14 , 10.91 ,Current Medicare Rates,11.14,11.02,Included in per diem,10.91,Included in ER Case rate,10.91,10.91, 11.25 ,10.332
Rx00904700906,RX,,00904700906,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL-NALOXONE HCL SL TAB 2-0.5 MG (BASE EQUIV),1,17.06, 16.21 ,16.72, 16.21 , 16.55 , 16.21 ,Current Medicare Rates,16.55,16.38,Included in per diem,16.21,Included in ER Case rate,16.21,16.21, 16.72 ,15.354
Rx65162041503,RX,,65162041503,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL-NALOXONE HCL SL TAB 8-2 MG (BASE EQUIV),1,16.07, 15.27 ,15.75, 15.27 , 15.59 , 15.27 ,Current Medicare Rates,15.59,15.43,Included in per diem,15.27,Included in ER Case rate,15.27,15.27, 15.75 ,14.463
Rx00054018913,RX,,00054018913,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL-NALOXONE HCL SL TAB 8-2 MG (BASE EQUIV),1,17.3, 16.44 ,16.95, 16.44 , 16.78 , 16.44 ,Current Medicare Rates,16.78,16.61,Included in per diem,16.44,Included in ER Case rate,16.44,16.44, 16.95 ,15.57
Rx50268014511,RX,,50268014511,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL-NALOXONE HCL SL TAB 8-2 MG (BASE EQUIV),1,21.91, 20.81 ,21.47, 20.81 , 21.25 , 20.81 ,Current Medicare Rates,21.25,21.03,Included in per diem,20.81,Included in ER Case rate,20.81,20.81, 21.47 ,19.719
Rx50268014515,RX,,50268014515,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL-NALOXONE HCL SL TAB 8-2 MG (BASE EQUIV),1,22.68, 21.55 ,22.23, 21.55 , 22.00 , 21.55 ,Current Medicare Rates,22,21.77,Included in per diem,21.55,Included in ER Case rate,21.55,21.55, 22.23 ,20.412
Rx62175045832,RX,,62175045832,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPRENORPHINE HCL-NALOXONE HCL SL TAB 8-2 MG (BASE EQUIV),1,12.64, 12.01 ,12.39, 12.01 , 12.26 , 12.01 ,Current Medicare Rates,12.26,12.13,Included in per diem,12.01,Included in ER Case rate,12.01,12.01, 12.39 ,11.376
Rx00113034403,RX,,00113034403,0250 - PHARMACY -  GENERAL CLASSIFICATION,NICOTINE POLACRILEX LOZENGE 2 MG,1,7.94, 7.54 ,7.78, 7.54 , 7.70 , 7.54 ,Current Medicare Rates,7.7,7.62,Included in per diem,7.54,Included in ER Case rate,7.54,7.54, 7.78 ,7.146
Rx63739011910,RX,,63739011910,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYBURIDE TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093834401,RX,,00093834401,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYBURIDE TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00536009185,RX,,00536009185,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALUMINUM HYDROXIDE GEL SUSP 320 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079073320,RX,,51079073320,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 0.5 MG,1,14.35, 13.63 ,14.06, 13.63 , 13.92 , 13.63 ,Current Medicare Rates,13.92,13.78,Included in per diem,13.63,Included in ER Case rate,13.63,13.63, 14.06 ,12.915
Rx51079073301,RX,,51079073301,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 0.5 MG,1,14.05, 13.35 ,13.77, 13.35 , 13.63 , 13.35 ,Current Medicare Rates,13.63,13.49,Included in per diem,13.35,Included in ER Case rate,13.35,13.35, 13.77 ,12.645
Rx00378035101,RX,,00378035101,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 0.5 MG,1,14.07, 13.37 ,13.79, 13.37 , 13.65 , 13.37 ,Current Medicare Rates,13.65,13.51,Included in per diem,13.37,Included in ER Case rate,13.37,13.37, 13.79 ,12.663
Rx00781139101,RX,,00781139101,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 0.5 MG,1,14.07, 13.37 ,13.79, 13.37 , 13.65 , 13.37 ,Current Medicare Rates,13.65,13.51,Included in per diem,13.37,Included in ER Case rate,13.37,13.37, 13.79 ,12.663
Rx00781139113,RX,,00781139113,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 0.5 MG,1,11.91, 11.31 ,11.67, 11.31 , 11.55 , 11.31 ,Current Medicare Rates,11.55,11.43,Included in per diem,11.31,Included in ER Case rate,11.31,11.31, 11.67 ,10.719
Rx51079073420,RX,,51079073420,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079073401,RX,,51079073401,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079073620,RX,,51079073620,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079073601,RX,,51079073601,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687016101,RX,,60687016101,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687016111,RX,,60687016111,0250 - PHARMACY -  GENERAL CLASSIFICATION,HALOPERIDOL TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx66758017013,RX,,66758017013,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,1,7.38, 7.01 ,7.23, 7.01 , 7.16 , 7.01 ,Current Medicare Rates,7.16,7.08,Included in per diem,7.01,Included in ER Case rate,7.01,7.01, 7.23 ,6.642
Rx66758017006,RX,,66758017006,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,1,7.38, 7.01 ,7.23, 7.01 , 7.16 , 7.01 ,Current Medicare Rates,7.16,7.08,Included in per diem,7.01,Included in ER Case rate,7.01,7.01, 7.23 ,6.642
Rx00245531789,RX,,00245531789,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,1,6.93, 6.58 ,6.79, 6.58 , 6.72 , 6.58 ,Current Medicare Rates,6.72,6.65,Included in per diem,6.58,Included in ER Case rate,6.58,6.58, 6.79 ,6.237
Rx00245531790,RX,,00245531790,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,1,8.16, 7.75 ,8, 7.75 , 7.92 , 7.75 ,Current Medicare Rates,7.92,7.83,Included in per diem,7.75,Included in ER Case rate,7.75,7.75, 8.00 ,7.344
Rx63739097210,RX,,63739097210,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 10 MEQ,1,7.77, 7.38 ,7.61, 7.38 , 7.54 , 7.38 ,Current Medicare Rates,7.54,7.46,Included in per diem,7.38,Included in ER Case rate,7.38,7.38, 7.61 ,6.993
Rx63739044710,RX,,63739044710,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx66758019006,RX,,66758019006,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00245531901,RX,,00245531901,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00245531989,RX,,00245531989,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00245531990,RX,,00245531990,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE MICROENCAPSULATED CRYS ER TAB 20 MEQ,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904651006,RX,,00904651006,0250 - PHARMACY -  GENERAL CLASSIFICATION,ARIPIPRAZOLE TAB 5 MG,1,11.64, 11.06 ,11.41, 11.06 , 11.29 , 11.06 ,Current Medicare Rates,11.29,11.17,Included in per diem,11.06,Included in ER Case rate,11.06,11.06, 11.41 ,10.476
Rx00121479905,RX,,00121479905,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM ORAL SOLN 100 MG/ML,1,16.93, 16.08 ,16.59, 16.08 , 16.42 , 16.08 ,Current Medicare Rates,16.42,16.25,Included in per diem,16.08,Included in ER Case rate,16.08,16.08, 16.59 ,15.237
Rx00121479940,RX,,00121479940,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM ORAL SOLN 100 MG/ML,1,12.63, 12.00 ,12.38, 12.00 , 12.25 , 12.00 ,Current Medicare Rates,12.25,12.12,Included in per diem,12,Included in ER Case rate,12,12, 12.38 ,11.367
Rx60687024967,RX,,60687024967,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM ORAL SOLN 100 MG/ML,1,14.3, 13.59 ,14.01, 13.59 , 13.87 , 13.59 ,Current Medicare Rates,13.87,13.73,Included in per diem,13.59,Included in ER Case rate,13.59,13.59, 14.01 ,12.87
Rx60687024940,RX,,60687024940,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM ORAL SOLN 100 MG/ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50268047011,RX,,50268047011,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM ORAL SOLN 100 MG/ML,1,15.85, 15.06 ,15.53, 15.06 , 15.37 , 15.06 ,Current Medicare Rates,15.37,15.22,Included in per diem,15.06,Included in ER Case rate,15.06,15.06, 15.53 ,14.265
Rx50268047013,RX,,50268047013,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVETIRACETAM ORAL SOLN 100 MG/ML,1,19.17, 18.21 ,18.79, 18.21 , 18.59 , 18.21 ,Current Medicare Rates,18.59,18.4,Included in per diem,18.21,Included in ER Case rate,18.21,18.21, 18.79 ,17.253
Rx60758077305,RX,,60758077305,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOROLAC TROMETHAMINE OPHTH SOLN 0.4%,1,185.65, 176.37 ,181.94, 176.37 , 180.08 , 176.37 ,Current Medicare Rates,180.08,178.22,Included in per diem,176.37,Included in ER Case rate,176.37,176.37, 181.94 ,167.085
Rx00121054410,RX,,00121054410,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOCUSATE SODIUM LIQUID 150 MG/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00904644061,RX,,00904644061,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDRALAZINE HCL TAB 10 MG,1,6.19, 5.88 ,6.07, 5.88 , 6.00 , 5.88 ,Current Medicare Rates,6,5.94,Included in per diem,5.88,Included in ER Case rate,5.88,5.88, 6.07 ,5.571
Rx51079007501,RX,,51079007501,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDRALAZINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904549261,RX,,00904549261,0250 - PHARMACY -  GENERAL CLASSIFICATION,MULTIPLE VITAMINS W/ MINERALS TAB,1,5.87, 5.58 ,5.75, 5.58 , 5.69 , 5.58 ,Current Medicare Rates,5.69,5.64,Included in per diem,5.58,Included in ER Case rate,5.58,5.58, 5.75 ,5.283
Rx00456320511,RX,,00456320511,0250 - PHARMACY -  GENERAL CLASSIFICATION,MEMANTINE HCL TAB 5 MG,1,26.53, 25.20 ,26, 25.20 , 25.73 , 25.20 ,Current Medicare Rates,25.73,25.47,Included in per diem,25.2,Included in ER Case rate,25.2,25.2, 26.00 ,23.877
Rx00904650561,RX,,00904650561,0250 - PHARMACY -  GENERAL CLASSIFICATION,MEMANTINE HCL TAB 5 MG,1,7.29, 6.93 ,7.14, 6.93 , 7.07 , 6.93 ,Current Medicare Rates,7.07,7,Included in per diem,6.93,Included in ER Case rate,6.93,6.93, 7.14 ,6.561
Rx63739012810,RX,,63739012810,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCHLOROTHIAZIDE TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687059301,RX,,60687059301,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCHLOROTHIAZIDE TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687059311,RX,,60687059311,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCHLOROTHIAZIDE TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00168001431,RX,,00168001431,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE CREAM 0.5%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00603390121,RX,,00603390121,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx59762007501,RX,,59762007501,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084093095,RX,,68084093095,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx04142000007,RX,,04142000007,0250 - PHARMACY -  GENERAL CLASSIFICATION,SACCHAROMYCES BOULARDII CAP 250 MG,1,10.19, 9.68 ,9.99, 9.68 , 9.88 , 9.68 ,Current Medicare Rates,9.88,9.78,Included in per diem,9.68,Included in ER Case rate,9.68,9.68, 9.99 ,9.171
Rx77333080050,RX,,77333080050,0250 - PHARMACY -  GENERAL CLASSIFICATION,SACCHAROMYCES BOULARDII CAP 250 MG,1,8.74, 8.30 ,8.57, 8.30 , 8.48 , 8.30 ,Current Medicare Rates,8.48,8.39,Included in per diem,8.3,Included in ER Case rate,8.3,8.3, 8.57 ,7.866
Rx77333080025,RX,,77333080025,0250 - PHARMACY -  GENERAL CLASSIFICATION,SACCHAROMYCES BOULARDII CAP 250 MG,1,8.75, 8.31 ,8.58, 8.31 , 8.49 , 8.31 ,Current Medicare Rates,8.49,8.4,Included in per diem,8.31,Included in ER Case rate,8.31,8.31, 8.58 ,7.875
Rx00713050312,RX,,00713050312,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE ACETATE SUPPOS 25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00713050306,RX,,00713050306,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCORTISONE ACETATE SUPPOS 25 MG,1,27.85, 26.46 ,27.29, 26.46 , 27.01 , 26.46 ,Current Medicare Rates,27.01,26.74,Included in per diem,26.46,Included in ER Case rate,26.46,26.46, 27.29 ,25.065
Rx00245003689,RX,,00245003689,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLESTYRAMINE LIGHT POWDER PACKETS 4 GM,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00132018582,RX,,00132018582,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYCERIN ENEMA ADULT 5.4 GM/AVERAGE DELIVERED DOSE,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00406324301,RX,,00406324301,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROMORPHONE HCL TAB 2 MG,1,6.94, 6.59 ,6.8, 6.59 , 6.73 , 6.59 ,Current Medicare Rates,6.73,6.66,Included in per diem,6.59,Included in ER Case rate,6.59,6.59, 6.80 ,6.246
Rx42858030125,RX,,42858030125,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROMORPHONE HCL TAB 2 MG,1,6.99, 6.64 ,6.85, 6.64 , 6.78 , 6.64 ,Current Medicare Rates,6.78,6.71,Included in per diem,6.64,Included in ER Case rate,6.64,6.64, 6.85 ,6.291
Rx68084042311,RX,,68084042311,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROMORPHONE HCL TAB 2 MG,1,6.87, 6.53 ,6.73, 6.53 , 6.66 , 6.53 ,Current Medicare Rates,6.66,6.6,Included in per diem,6.53,Included in ER Case rate,6.53,6.53, 6.73 ,6.183
Rx51079025520,RX,,51079025520,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx51079025501,RX,,51079025501,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx62584026511,RX,,62584026511,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00904634061,RX,,00904634061,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00591090030,RX,,00591090030,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIPIZIDE TAB ER 24HR 2.5 MG,1,7.18, 6.82 ,7.04, 6.82 , 6.96 , 6.82 ,Current Medicare Rates,6.96,6.89,Included in per diem,6.82,Included in ER Case rate,6.82,6.82, 7.04 ,6.462
Rx68084029511,RX,,68084029511,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIPIZIDE TAB ER 24HR 2.5 MG,1,11.2, 10.64 ,10.98, 10.64 , 10.86 , 10.64 ,Current Medicare Rates,10.86,10.75,Included in per diem,10.64,Included in ER Case rate,10.64,10.64, 10.98 ,10.08
Rx68084011111,RX,,68084011111,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIPIZIDE TAB ER 24HR 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx49884074501,RX,,49884074501,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLIPIZIDE TAB ER 24HR 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63824000815,RX,,63824000815,0250 - PHARMACY -  GENERAL CLASSIFICATION,GUAIFENESIN TAB ER 12HR 600 MG,1,7.26, 6.90 ,7.11, 6.90 , 7.04 , 6.90 ,Current Medicare Rates,7.04,6.97,Included in per diem,6.9,Included in ER Case rate,6.9,6.9, 7.11 ,6.534
Rx68084057201,RX,,68084057201,0250 - PHARMACY -  GENERAL CLASSIFICATION,GUAIFENESIN TAB ER 12HR 600 MG,1,10.4, 9.88 ,10.19, 9.88 , 10.09 , 9.88 ,Current Medicare Rates,10.09,9.98,Included in per diem,9.88,Included in ER Case rate,9.88,9.88, 10.19 ,9.36
Rx68084057211,RX,,68084057211,0250 - PHARMACY -  GENERAL CLASSIFICATION,GUAIFENESIN TAB ER 12HR 600 MG,1,10.05, 9.55 ,9.85, 9.55 , 9.75 , 9.55 ,Current Medicare Rates,9.75,9.65,Included in per diem,9.55,Included in ER Case rate,9.55,9.55, 9.85 ,9.045
Rx00121482225,RX,,00121482225,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROXYZINE HCL SYRUP 10 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx17856015001,RX,,17856015001,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROXYZINE HCL SYRUP 10 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68084084701,RX,,68084084701,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROXYZINE PAMOATE CAP 25 MG,1,8.28, 7.87 ,8.11, 7.87 , 8.03 , 7.87 ,Current Medicare Rates,8.03,7.95,Included in per diem,7.87,Included in ER Case rate,7.87,7.87, 8.11 ,7.452
Rx68084084711,RX,,68084084711,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROXYZINE PAMOATE CAP 25 MG,1,7.41, 7.04 ,7.26, 7.04 , 7.19 , 7.04 ,Current Medicare Rates,7.19,7.11,Included in per diem,7.04,Included in ER Case rate,7.04,7.04, 7.26 ,6.669
Rx51079007701,RX,,51079007701,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROXYZINE PAMOATE CAP 25 MG,1,6.21, 5.90 ,6.09, 5.90 , 6.02 , 5.90 ,Current Medicare Rates,6.02,5.96,Included in per diem,5.9,Included in ER Case rate,5.9,5.9, 6.09 ,5.589
Rx76439030810,RX,,76439030810,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYOSCYAMINE SULFATE TAB 0.125 MG,1,6.87, 6.53 ,6.73, 6.53 , 6.66 , 6.53 ,Current Medicare Rates,6.66,6.6,Included in per diem,6.53,Included in ER Case rate,6.53,6.53, 6.73 ,6.183
Rx66689002301,RX,,66689002301,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,1,6.91, 6.56 ,6.77, 6.56 , 6.70 , 6.56 ,Current Medicare Rates,6.7,6.63,Included in per diem,6.56,Included in ER Case rate,6.56,6.56, 6.77 ,6.219
Rx66689002350,RX,,66689002350,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,1,6.88, 6.54 ,6.74, 6.54 , 6.67 , 6.54 ,Current Medicare Rates,6.67,6.6,Included in per diem,6.54,Included in ER Case rate,6.54,6.54, 6.74 ,6.192
Rx00121231615,RX,,00121231615,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,1,8.75, 8.31 ,8.58, 8.31 , 8.49 , 8.31 ,Current Medicare Rates,8.49,8.4,Included in per diem,8.31,Included in ER Case rate,8.31,8.31, 8.58 ,7.875
Rx60687041744,RX,,60687041744,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60687041771,RX,,60687041771,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325 MG/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00121457715,RX,,00121457715,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTULOSE SOLUTION 10 GM/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50383077915,RX,,50383077915,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTULOSE SOLUTION 10 GM/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx66689003901,RX,,66689003901,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTULOSE SOLUTION 10 GM/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00603137858,RX,,00603137858,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTULOSE SOLUTION 10 GM/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60432003708,RX,,60432003708,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTULOSE SOLUTION 10 GM/15ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00597007575,RX,,00597007575,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIOTROPIUM BROMIDE MONOHYDRATE INHAL CAP 18 MCG (BASE EQUIV),1,169.95, 161.45 ,166.55, 161.45 , 164.85 , 161.45 ,Current Medicare Rates,164.85,163.15,Included in per diem,161.45,Included in ER Case rate,161.45,161.45, 166.55 ,152.955
Rx50580011051,RX,,50580011051,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 200 MG,1,5.72, 5.43 ,5.61, 5.43 , 5.55 , 5.43 ,Current Medicare Rates,5.55,5.49,Included in per diem,5.43,Included in ER Case rate,5.43,5.43, 5.61 ,5.148
Rx00904791461,RX,,00904791461,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 200 MG,1,5.9, 5.61 ,5.78, 5.61 , 5.72 , 5.61 ,Current Medicare Rates,5.72,5.66,Included in per diem,5.61,Included in ER Case rate,5.61,5.61, 5.78 ,5.31
Rx00904585361,RX,,00904585361,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 400 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904585461,RX,,00904585461,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 600 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739068410,RX,,63739068410,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 600 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904585561,RX,,00904585561,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 800 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739069110,RX,,63739069110,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 800 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687046801,RX,,60687046801,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 800 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687046811,RX,,60687046811,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN TAB 800 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00781176401,RX,,00781176401,0250 - PHARMACY -  GENERAL CLASSIFICATION,IMIPRAMINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00781176413,RX,,00781176413,0250 - PHARMACY -  GENERAL CLASSIFICATION,IMIPRAMINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx49884005501,RX,,49884005501,0250 - PHARMACY -  GENERAL CLASSIFICATION,IMIPRAMINE HCL TAB 25 MG,1,6.03, 5.73 ,5.91, 5.73 , 5.85 , 5.73 ,Current Medicare Rates,5.85,5.79,Included in per diem,5.73,Included in ER Case rate,5.73,5.73, 5.91 ,5.427
Rx43386006019,RX,,43386006019,0250 - PHARMACY -  GENERAL CLASSIFICATION,PEG 3350-KCL-NA BICARB-NACL-NA SULFATE FOR SOLN 240 GM,1,55.62, 52.84 ,54.51, 52.84 , 53.95 , 52.84 ,Current Medicare Rates,53.95,53.4,Included in per diem,52.84,Included in ER Case rate,52.84,52.84, 54.51 ,50.058
Rx68462040601,RX,,68462040601,0250 - PHARMACY -  GENERAL CLASSIFICATION,INDOMETHACIN CAP 25 MG,1,6.05, 5.75 ,5.93, 5.75 , 5.87 , 5.75 ,Current Medicare Rates,5.87,5.81,Included in per diem,5.75,Included in ER Case rate,5.75,5.75, 5.93 ,5.445
Rx31722054201,RX,,31722054201,0250 - PHARMACY -  GENERAL CLASSIFICATION,INDOMETHACIN CAP 25 MG,1,6.67, 6.34 ,6.54, 6.34 , 6.47 , 6.34 ,Current Medicare Rates,6.47,6.4,Included in per diem,6.34,Included in ER Case rate,6.34,6.34, 6.54 ,6.003
Rx50268043011,RX,,50268043011,0250 - PHARMACY -  GENERAL CLASSIFICATION,INDOMETHACIN CAP 25 MG,1,6.84, 6.50 ,6.7, 6.50 , 6.63 , 6.50 ,Current Medicare Rates,6.63,6.57,Included in per diem,6.5,Included in ER Case rate,6.5,6.5, 6.70 ,6.156
Rx50268043015,RX,,50268043015,0250 - PHARMACY -  GENERAL CLASSIFICATION,INDOMETHACIN CAP 25 MG,1,6.92, 6.57 ,6.78, 6.57 , 6.71 , 6.57 ,Current Medicare Rates,6.71,6.64,Included in per diem,6.57,Included in ER Case rate,6.57,6.57, 6.78 ,6.228
Rx51079019001,RX,,51079019001,0250 - PHARMACY -  GENERAL CLASSIFICATION,INDOMETHACIN CAP 25 MG,1,7.93, 7.53 ,7.77, 7.53 , 7.69 , 7.53 ,Current Medicare Rates,7.69,7.61,Included in per diem,7.53,Included in ER Case rate,7.53,7.53, 7.77 ,7.137
Rx51079019020,RX,,51079019020,0250 - PHARMACY -  GENERAL CLASSIFICATION,INDOMETHACIN CAP 25 MG,1,6.74, 6.40 ,6.61, 6.40 , 6.54 , 6.40 ,Current Medicare Rates,6.54,6.47,Included in per diem,6.4,Included in ER Case rate,6.4,6.4, 6.61 ,6.066
Rx00832046515,RX,,00832046515,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN TOPICAL POWDER 100000 UNIT/GM,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx39822301501,RX,,39822301501,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN TOPICAL POWDER 100000 UNIT/GM,1,22.38, 21.26 ,21.93, 21.26 , 21.71 , 21.26 ,Current Medicare Rates,21.71,21.48,Included in per diem,21.26,Included in ER Case rate,21.26,21.26, 21.93 ,20.142
Rx00574200815,RX,,00574200815,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN TOPICAL POWDER 100000 UNIT/GM,1,83.08, 78.93 ,81.42, 78.93 , 80.59 , 78.93 ,Current Medicare Rates,80.59,79.76,Included in per diem,78.93,Included in ER Case rate,78.93,78.93, 81.42 ,74.772
Rx61958070101,RX,,61958070101,0250 - PHARMACY -  GENERAL CLASSIFICATION,EMTRICITABINE-TENOFOVIR DISOPROXIL FUMARATE TAB 200-300 MG,1,160.7, 152.67 ,157.49, 152.67 , 155.88 , 152.67 ,Current Medicare Rates,155.88,154.27,Included in per diem,152.67,Included in ER Case rate,152.67,152.67, 157.49 ,144.63
Rx68084067511,RX,,68084067511,0250 - PHARMACY -  GENERAL CLASSIFICATION,DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ),1,10.42, 9.90 ,10.21, 9.90 , 10.11 , 9.90 ,Current Medicare Rates,10.11,10,Included in per diem,9.9,Included in ER Case rate,9.9,9.9, 10.21 ,9.378
Rx00904645204,RX,,00904645204,0250 - PHARMACY -  GENERAL CLASSIFICATION,DULOXETINE HCL ENTERIC COATED PELLETS CAP 20 MG (BASE EQ),1,10.4, 9.88 ,10.19, 9.88 , 10.09 , 9.88 ,Current Medicare Rates,10.09,9.98,Included in per diem,9.88,Included in ER Case rate,9.88,9.88, 10.19 ,9.36
Rx00904645361,RX,,00904645361,0250 - PHARMACY -  GENERAL CLASSIFICATION,DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ),1,6.49, 6.17 ,6.36, 6.17 , 6.30 , 6.17 ,Current Medicare Rates,6.3,6.23,Included in per diem,6.17,Included in ER Case rate,6.17,6.17, 6.36 ,5.841
Rx00904704461,RX,,00904704461,0250 - PHARMACY -  GENERAL CLASSIFICATION,DULOXETINE HCL ENTERIC COATED PELLETS CAP 30 MG (BASE EQ),1,6.79, 6.45 ,6.65, 6.45 , 6.59 , 6.45 ,Current Medicare Rates,6.59,6.52,Included in per diem,6.45,Included in ER Case rate,6.45,6.45, 6.65 ,6.111
Rx51079024101,RX,,51079024101,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACAMPROSATE CALCIUM TAB DELAYED RELEASE 333 MG,1,10.02, 9.52 ,9.82, 9.52 , 9.72 , 9.52 ,Current Medicare Rates,9.72,9.62,Included in per diem,9.52,Included in ER Case rate,9.52,9.52, 9.82 ,9.018
Rx60687012125,RX,,60687012125,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACAMPROSATE CALCIUM TAB DELAYED RELEASE 333 MG,1,17.49, 16.62 ,17.14, 16.62 , 16.97 , 16.62 ,Current Medicare Rates,16.97,16.79,Included in per diem,16.62,Included in ER Case rate,16.62,16.62, 17.14 ,15.741
Rx60687012195,RX,,60687012195,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACAMPROSATE CALCIUM TAB DELAYED RELEASE 333 MG,1,15.05, 14.30 ,14.75, 14.30 , 14.60 , 14.30 ,Current Medicare Rates,14.6,14.45,Included in per diem,14.3,Included in ER Case rate,14.3,14.3, 14.75 ,13.545
Rx65628005001,RX,,65628005001,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIPHENHYD-LIDO-AL HYDROX-MG HYDROX-SIMETH SUSP (CMPD KIT),1,266.56, 253.23 ,261.23, 253.23 , 258.56 , 253.23 ,Current Medicare Rates,258.56,255.9,Included in per diem,253.23,Included in ER Case rate,253.23,253.23, 261.23 ,239.904
Rx63736003751,RX,,63736003751,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZOCAINE RECTAL OINTMENT 20%,1,23.97, 22.77 ,23.49, 22.77 , 23.25 , 22.77 ,Current Medicare Rates,23.25,23.01,Included in per diem,22.77,Included in ER Case rate,22.77,22.77, 23.49 ,21.573
Rx00143177101,RX,,00143177101,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 10 MG,1,8.45, 8.03 ,8.28, 8.03 , 8.20 , 8.03 ,Current Medicare Rates,8.2,8.11,Included in per diem,8.03,Included in ER Case rate,8.03,8.03, 8.28 ,7.605
Rx68084008201,RX,,68084008201,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 10 MG,1,10.54, 10.01 ,10.33, 10.01 , 10.22 , 10.01 ,Current Medicare Rates,10.22,10.12,Included in per diem,10.01,Included in ER Case rate,10.01,10.01, 10.33 ,9.486
Rx68084008211,RX,,68084008211,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 10 MG,1,8.18, 7.77 ,8.02, 7.77 , 7.93 , 7.77 ,Current Medicare Rates,7.93,7.85,Included in per diem,7.77,Included in ER Case rate,7.77,7.77, 8.02 ,7.362
Rx00781155613,RX,,00781155613,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 10 MG,1,8.33, 7.91 ,8.16, 7.91 , 8.08 , 7.91 ,Current Medicare Rates,8.08,8,Included in per diem,7.91,Included in ER Case rate,7.91,7.91, 8.16 ,7.497
Rx50268044811,RX,,50268044811,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 10 MG,1,8.4, 7.98 ,8.23, 7.98 , 8.15 , 7.98 ,Current Medicare Rates,8.15,8.06,Included in per diem,7.98,Included in ER Case rate,7.98,7.98, 8.23 ,7.56
Rx50268044815,RX,,50268044815,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 10 MG,1,8.39, 7.97 ,8.22, 7.97 , 8.14 , 7.97 ,Current Medicare Rates,8.14,8.05,Included in per diem,7.97,Included in ER Case rate,7.97,7.97, 8.22 ,7.551
Rx00904661961,RX,,00904661961,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 10 MG,1,7.99, 7.59 ,7.83, 7.59 , 7.75 , 7.59 ,Current Medicare Rates,7.75,7.67,Included in per diem,7.59,Included in ER Case rate,7.59,7.59, 7.83 ,7.191
Rx00143176901,RX,,00143176901,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 5 MG,1,8.32, 7.90 ,8.15, 7.90 , 8.07 , 7.90 ,Current Medicare Rates,8.07,7.99,Included in per diem,7.9,Included in ER Case rate,7.9,7.9, 8.15 ,7.488
Rx50268044711,RX,,50268044711,0250 - PHARMACY -  GENERAL CLASSIFICATION,ISOSORBIDE DINITRATE TAB 5 MG,1,10.07, 9.57 ,9.87, 9.57 , 9.77 , 9.57 ,Current Medicare Rates,9.77,9.67,Included in per diem,9.57,Included in ER Case rate,9.57,9.57, 9.87 ,9.063
Rx00173071920,RX,,00173071920,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUTICASONE PROPIONATE HFA INHAL AER 110 MCG/ACT (125/VALVE),1,622.31, 591.19 ,609.86, 591.19 , 603.64 , 591.19 ,Current Medicare Rates,603.64,597.42,Included in per diem,591.19,Included in ER Case rate,591.19,591.19, 609.86 ,560.079
Rx00132007912,RX,,00132007912,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYCERIN SUPPOS 2 GM,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00713010109,RX,,00713010109,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLYCERIN SUPPOS 2 GM,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00378911998,RX,,00378911998,0250 - PHARMACY -  GENERAL CLASSIFICATION,FENTANYL TD PATCH 72HR 12 MCG/HR,1,35.95, 34.15 ,35.23, 34.15 , 34.87 , 34.15 ,Current Medicare Rates,34.87,34.51,Included in per diem,34.15,Included in ER Case rate,34.15,34.15, 35.23 ,32.355
Rx00085134106,RX,,00085134106,0250 - PHARMACY -  GENERAL CLASSIFICATION,MOMETASONE FUROATE INHAL POWD 220 MCG/INH (BREATH ACTIVATED),1,245.55, 233.27 ,240.64, 233.27 , 238.18 , 233.27 ,Current Medicare Rates,238.18,235.73,Included in per diem,233.27,Included in ER Case rate,233.27,233.27, 240.64 ,220.995
Rx00168020437,RX,,00168020437,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE OINT 5%,1,742.3, 705.19 ,727.45, 705.19 , 720.03 , 705.19 ,Current Medicare Rates,720.03,712.61,Included in per diem,705.19,Included in ER Case rate,705.19,705.19, 727.45 ,668.07
Rx51672302009,RX,,51672302009,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE OINT 5%,1,284.25, 270.04 ,278.57, 270.04 , 275.72 , 270.04 ,Current Medicare Rates,275.72,272.88,Included in per diem,270.04,Included in ER Case rate,270.04,270.04, 278.57 ,255.825
Rx68462041820,RX,,68462041820,0250 - PHARMACY -  GENERAL CLASSIFICATION,LIDOCAINE OINT 5%,1,36.13, 34.32 ,35.41, 34.32 , 35.05 , 34.32 ,Current Medicare Rates,35.05,34.68,Included in per diem,34.32,Included in ER Case rate,34.32,34.32, 35.41 ,32.517
Rx00071101341,RX,,00071101341,0250 - PHARMACY -  GENERAL CLASSIFICATION,PREGABALIN CAP 50 MG,1,20.22, 19.21 ,19.82, 19.21 , 19.61 , 19.21 ,Current Medicare Rates,19.61,19.41,Included in per diem,19.21,Included in ER Case rate,19.21,19.21, 19.82 ,18.198
Rx00904699261,RX,,00904699261,0250 - PHARMACY -  GENERAL CLASSIFICATION,PREGABALIN CAP 50 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00071101441,RX,,00071101441,0250 - PHARMACY -  GENERAL CLASSIFICATION,PREGABALIN CAP 75 MG,1,13.48, 12.81 ,13.21, 12.81 , 13.08 , 12.81 ,Current Medicare Rates,13.08,12.94,Included in per diem,12.81,Included in ER Case rate,12.81,12.81, 13.21 ,12.132
Rx00904700061,RX,,00904700061,0250 - PHARMACY -  GENERAL CLASSIFICATION,PREGABALIN CAP 75 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx77333071510,RX,,77333071510,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG,1,6.39, 6.07 ,6.26, 6.07 , 6.20 , 6.07 ,Current Medicare Rates,6.2,6.13,Included in per diem,6.07,Included in ER Case rate,6.07,6.07, 6.26 ,5.751
Rx77333071525,RX,,77333071525,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRENATAL VIT W/ FE FUMARATE-FA TAB 27-0.8 MG,1,6.4, 6.08 ,6.27, 6.08 , 6.21 , 6.08 ,Current Medicare Rates,6.21,6.14,Included in per diem,6.08,Included in ER Case rate,6.08,6.08, 6.27 ,5.76
Rx16729017101,RX,,16729017101,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMITRIPTYLINE HCL TAB 10 MG,1,5.87, 5.58 ,5.75, 5.58 , 5.69 , 5.58 ,Current Medicare Rates,5.69,5.64,Included in per diem,5.58,Included in ER Case rate,5.58,5.58, 5.75 ,5.283
Rx51079013101,RX,,51079013101,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMITRIPTYLINE HCL TAB 10 MG,1,6.68, 6.35 ,6.55, 6.35 , 6.48 , 6.35 ,Current Medicare Rates,6.48,6.41,Included in per diem,6.35,Included in ER Case rate,6.35,6.35, 6.55 ,6.012
Rx60687043301,RX,,60687043301,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMITRIPTYLINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687043311,RX,,60687043311,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMITRIPTYLINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079010701,RX,,51079010701,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMITRIPTYLINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079013301,RX,,51079013301,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMITRIPTYLINE HCL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079044401,RX,,51079044401,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 25 MCG,1,7.85, 7.46 ,7.69, 7.46 , 7.61 , 7.46 ,Current Medicare Rates,7.61,7.54,Included in per diem,7.46,Included in ER Case rate,7.46,7.46, 7.69 ,7.065
Rx60687045301,RX,,60687045301,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 25 MCG,1,8.11, 7.70 ,7.95, 7.70 , 7.87 , 7.70 ,Current Medicare Rates,7.87,7.79,Included in per diem,7.7,Included in ER Case rate,7.7,7.7, 7.95 ,7.299
Rx60687045311,RX,,60687045311,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 25 MCG,1,7.34, 6.97 ,7.19, 6.97 , 7.12 , 6.97 ,Current Medicare Rates,7.12,7.05,Included in per diem,6.97,Included in ER Case rate,6.97,6.97, 7.19 ,6.606
Rx51079044001,RX,,51079044001,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 50 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687046401,RX,,60687046401,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 50 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687046411,RX,,60687046411,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 50 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00074455211,RX,,00074455211,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 50 MCG,1,6.39, 6.07 ,6.26, 6.07 , 6.20 , 6.07 ,Current Medicare Rates,6.2,6.13,Included in per diem,6.07,Included in ER Case rate,6.07,6.07, 6.26 ,5.751
Rx51079044101,RX,,51079044101,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 75 MCG,1,11.3, 10.74 ,11.07, 10.74 , 10.96 , 10.74 ,Current Medicare Rates,10.96,10.85,Included in per diem,10.74,Included in ER Case rate,10.74,10.74, 11.07 ,10.17
Rx00904695161,RX,,00904695161,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 75 MCG,1,10.43, 9.91 ,10.22, 9.91 , 10.12 , 9.91 ,Current Medicare Rates,10.12,10.01,Included in per diem,9.91,Included in ER Case rate,9.91,9.91, 10.22 ,9.387
Rx00074518211,RX,,00074518211,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 75 MCG,1,17.06, 16.21 ,16.72, 16.21 , 16.55 , 16.21 ,Current Medicare Rates,16.55,16.38,Included in per diem,16.21,Included in ER Case rate,16.21,16.21, 16.72 ,15.354
Rx51079044201,RX,,51079044201,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 100 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079044220,RX,,51079044220,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 100 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00074662411,RX,,00074662411,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 100 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079044301,RX,,51079044301,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 125 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00074706811,RX,,00074706811,0250 - PHARMACY -  GENERAL CLASSIFICATION,LEVOTHYROXINE SODIUM TAB 125 MCG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00781202001,RX,,00781202001,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) CAP 250 MG,1,5.9, 5.61 ,5.78, 5.61 , 5.72 , 5.61 ,Current Medicare Rates,5.72,5.66,Included in per diem,5.61,Included in ER Case rate,5.61,5.61, 5.78 ,5.31
Rx16714029801,RX,,16714029801,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) CAP 250 MG,1,5.94, 5.64 ,5.82, 5.64 , 5.76 , 5.64 ,Current Medicare Rates,5.76,5.7,Included in per diem,5.64,Included in ER Case rate,5.64,5.64, 5.82 ,5.346
Rx16714029903,RX,,16714029903,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) CAP 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093226801,RX,,00093226801,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) CHEW TAB 250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739035010,RX,,63739035010,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx43547035410,RX,,43547035410,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx43547035411,RX,,43547035411,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687033301,RX,,60687033301,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687033311,RX,,60687033311,0250 - PHARMACY -  GENERAL CLASSIFICATION,LISINOPRIL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00143988880,RX,,00143988880,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 125 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00054852825,RX,,00054852825,0250 - PHARMACY -  GENERAL CLASSIFICATION,LITHIUM CARBONATE TAB 300 MG,1,6.63, 6.30 ,6.5, 6.30 , 6.43 , 6.30 ,Current Medicare Rates,6.43,6.36,Included in per diem,6.3,Included in ER Case rate,6.3,6.3, 6.50 ,5.967
Rx00781604158,RX,,00781604158,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00093415579,RX,,00093415579,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079069001,RX,,51079069001,0250 - PHARMACY -  GENERAL CLASSIFICATION,LOPERAMIDE HCL CAP 2 MG,1,9.3, 8.84 ,9.11, 8.84 , 9.02 , 8.84 ,Current Medicare Rates,9.02,8.93,Included in per diem,8.84,Included in ER Case rate,8.84,8.84, 9.11 ,8.37
Rx60687022901,RX,,60687022901,0250 - PHARMACY -  GENERAL CLASSIFICATION,LOPERAMIDE HCL CAP 2 MG,1,8.2, 7.79 ,8.04, 7.79 , 7.95 , 7.79 ,Current Medicare Rates,7.95,7.87,Included in per diem,7.79,Included in ER Case rate,7.79,7.79, 8.04 ,7.38
Rx60687022911,RX,,60687022911,0250 - PHARMACY -  GENERAL CLASSIFICATION,LOPERAMIDE HCL CAP 2 MG,1,8.21, 7.80 ,8.05, 7.80 , 7.96 , 7.80 ,Current Medicare Rates,7.96,7.88,Included in per diem,7.8,Included in ER Case rate,7.8,7.8, 8.05 ,7.389
Rx00121077001,RX,,00121077001,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM CONC 2 MG/ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00054353244,RX,,00054353244,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM CONC 2 MG/ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00904600760,RX,,00904600760,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 0.5 MG,1,6.46, 6.14 ,6.33, 6.14 , 6.27 , 6.14 ,Current Medicare Rates,6.27,6.2,Included in per diem,6.14,Included in ER Case rate,6.14,6.14, 6.33 ,5.814
Rx63739049910,RX,,63739049910,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 0.5 MG,1,6.52, 6.19 ,6.39, 6.19 , 6.32 , 6.19 ,Current Medicare Rates,6.32,6.26,Included in per diem,6.19,Included in ER Case rate,6.19,6.19, 6.39 ,5.868
Rx00591024001,RX,,00591024001,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 0.5 MG,1,6.4, 6.08 ,6.27, 6.08 , 6.21 , 6.08 ,Current Medicare Rates,6.21,6.14,Included in per diem,6.08,Included in ER Case rate,6.08,6.08, 6.27 ,5.76
Rx00904600761,RX,,00904600761,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 0.5 MG,1,6.53, 6.20 ,6.4, 6.20 , 6.33 , 6.20 ,Current Medicare Rates,6.33,6.27,Included in per diem,6.2,Included in ER Case rate,6.2,6.2, 6.40 ,5.877
Rx51079038601,RX,,51079038601,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 1 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx63739050010,RX,,63739050010,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 1 MG,1,6.53, 6.20 ,6.4, 6.20 , 6.33 , 6.20 ,Current Medicare Rates,6.33,6.27,Included in per diem,6.2,Included in ER Case rate,6.2,6.2, 6.40 ,5.877
Rx00591024101,RX,,00591024101,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 1 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx69315090501,RX,,69315090501,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 1 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00904600861,RX,,00904600861,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 1 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60687035501,RX,,60687035501,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 1 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60687035511,RX,,60687035511,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM TAB 1 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00000481001,RX,,00000481001,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN 5-325 MG (ED PREPACK) PO TABS,1,28.82, 27.38 ,28.24, 27.38 , 27.96 , 27.38 ,Current Medicare Rates,27.96,27.67,Included in per diem,27.38,Included in ER Case rate,27.38,27.38, 28.24 ,25.938
Rx00000001086,RX,,00000001086,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN 250 MG (ED PREPACK) PO CAPS,1,23.74, 22.55 ,23.27, 22.55 , 23.03 , 22.55 ,Current Medicare Rates,23.03,22.79,Included in per diem,22.55,Included in ER Case rate,22.55,22.55, 23.27 ,21.366
Rx00001481005,RX,,00001481005,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN-POT CLAVULANATE 875-125 MG (ED PREPACK) PO TABS,1,33.12, 31.46 ,32.46, 31.46 , 32.13 , 31.46 ,Current Medicare Rates,32.13,31.8,Included in per diem,31.46,Included in ER Case rate,31.46,31.46, 32.46 ,29.808
Rx00000481010,RX,,00000481010,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROMORPHONE HCL 2 MG (ED PREPACK) PO TABS,1,27.55, 26.17 ,27, 26.17 , 26.72 , 26.17 ,Current Medicare Rates,26.72,26.45,Included in per diem,26.17,Included in ER Case rate,26.17,26.17, 27.00 ,24.795
Rx00000001138,RX,,00000001138,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENICILLIN V POTASSIUM 250 MG (ED PREPACK) PO TABS,1,24.08, 22.88 ,23.6, 22.88 , 23.36 , 22.88 ,Current Medicare Rates,23.36,23.12,Included in per diem,22.88,Included in ER Case rate,22.88,22.88, 23.60 ,21.672
Rx00001481017,RX,,00001481017,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG (ED PREPACK) PO TABS,1,26.44, 25.12 ,25.91, 25.12 , 25.65 , 25.12 ,Current Medicare Rates,25.65,25.38,Included in per diem,25.12,Included in ER Case rate,25.12,25.12, 25.91 ,23.796
Rx00000481022,RX,,00000481022,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORDIAZEPOXIDE HCL 25 MG (ED PREPACK) PO CAPS,1,25.58, 24.30 ,25.07, 24.30 , 24.81 , 24.30 ,Current Medicare Rates,24.81,24.56,Included in per diem,24.3,Included in ER Case rate,24.3,24.3, 25.07 ,23.022
Rx00000000484,RX,,00000000484,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMANTADINE HCL CAP 100 MG,1,18.59, 17.66 ,18.22, 17.66 , 18.03 , 17.66 ,Current Medicare Rates,18.03,17.85,Included in per diem,17.66,Included in ER Case rate,17.66,17.66, 18.22 ,16.731
Rx00000000485,RX,,00000000485,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMLODIPINE BESYLATE TAB 5 MG,1,12.12, 11.51 ,11.88, 11.51 , 11.76 , 11.51 ,Current Medicare Rates,11.76,11.64,Included in per diem,11.51,Included in ER Case rate,11.51,11.51, 11.88 ,10.908
Rx00000000486,RX,,00000000486,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATENOLOL TAB 50 MG,1,11.94, 11.34 ,11.7, 11.34 , 11.58 , 11.34 ,Current Medicare Rates,11.58,11.46,Included in per diem,11.34,Included in ER Case rate,11.34,11.34, 11.70 ,10.746
Rx00000000489,RX,,00000000489,0250 - PHARMACY -  GENERAL CLASSIFICATION,COLCHICINE TAB 0.6 MG,1,118.19, 112.28 ,115.83, 112.28 , 114.64 , 112.28 ,Current Medicare Rates,114.64,113.46,Included in per diem,112.28,Included in ER Case rate,112.28,112.28, 115.83 ,106.371
Rx00000000490,RX,,00000000490,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIGOXIN TAB 125 MCG (0.125 MG),1,36.78, 34.94 ,36.04, 34.94 , 35.68 , 34.94 ,Current Medicare Rates,35.68,35.31,Included in per diem,34.94,Included in ER Case rate,34.94,34.94, 36.04 ,33.102
Rx00000000495,RX,,00000000495,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE TAB 20 MG,1,11.84, 11.25 ,11.6, 11.25 , 11.48 , 11.25 ,Current Medicare Rates,11.48,11.37,Included in per diem,11.25,Included in ER Case rate,11.25,11.25, 11.60 ,10.656
Rx00000000498,RX,,00000000498,0250 - PHARMACY -  GENERAL CLASSIFICATION,INDOMETHACIN CAP 25 MG,1,40.24, 38.23 ,39.44, 38.23 , 39.03 , 38.23 ,Current Medicare Rates,39.03,38.63,Included in per diem,38.23,Included in ER Case rate,38.23,38.23, 39.44 ,36.216
Rx00000000501,RX,,00000000501,0250 - PHARMACY -  GENERAL CLASSIFICATION,METFORMIN HCL TAB 500 MG,1,12.05, 11.45 ,11.81, 11.45 , 11.69 , 11.45 ,Current Medicare Rates,11.69,11.57,Included in per diem,11.45,Included in ER Case rate,11.45,11.45, 11.81 ,10.845
Rx00000000503,RX,,00000000503,0250 - PHARMACY -  GENERAL CLASSIFICATION,OMEPRAZOLE CAP DELAYED RELEASE 20 MG,1,13.18, 12.52 ,12.92, 12.52 , 12.78 , 12.52 ,Current Medicare Rates,12.78,12.65,Included in per diem,12.52,Included in ER Case rate,12.52,12.52, 12.92 ,11.862
Rx00000000504,RX,,00000000504,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SODIUM EXTENDED CAP 100 MG,1,33.12, 31.46 ,32.46, 31.46 , 32.13 , 31.46 ,Current Medicare Rates,32.13,31.8,Included in per diem,31.46,Included in ER Case rate,31.46,31.46, 32.46 ,29.808
Rx00000000508,RX,,00000000508,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE TAB 25 MG,1,25.35, 24.08 ,24.84, 24.08 , 24.59 , 24.08 ,Current Medicare Rates,24.59,24.34,Included in per diem,24.08,Included in ER Case rate,24.08,24.08, 24.84 ,22.815
Rx00000005097,RX,,00000005097,0250 - PHARMACY -  GENERAL CLASSIFICATION,TAMSULOSIN HCL CAP 0.4 MG,1,6.98, 6.63 ,6.84, 6.63 , 6.77 , 6.63 ,Current Medicare Rates,6.77,6.7,Included in per diem,6.63,Included in ER Case rate,6.63,6.63, 6.84 ,6.282
Rx00000000510,RX,,00000000510,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALACYCLOVIR HCL TAB 500 MG,1,38.31, 36.39 ,37.54, 36.39 , 37.16 , 36.39 ,Current Medicare Rates,37.16,36.78,Included in per diem,36.39,Included in ER Case rate,36.39,36.39, 37.54 ,34.479
Rx00555087202,RX,,00555087202,0250 - PHARMACY -  GENERAL CLASSIFICATION,MEDROXYPROGESTERONE ACETATE TAB 2.5 MG,1,6.28, 5.97 ,6.15, 5.97 , 6.09 , 5.97 ,Current Medicare Rates,6.09,6.03,Included in per diem,5.97,Included in ER Case rate,5.97,5.97, 6.15 ,5.652
Rx00406575562,RX,,00406575562,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHADONE HCL TAB 5 MG,1,7.54, 7.16 ,7.39, 7.16 , 7.31 , 7.16 ,Current Medicare Rates,7.31,7.24,Included in per diem,7.16,Included in ER Case rate,7.16,7.16, 7.39 ,6.786
Rx63739016610,RX,,63739016610,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHOCARBAMOL TAB 500 MG,1,6.3, 5.99 ,6.17, 5.99 , 6.11 , 5.99 ,Current Medicare Rates,6.11,6.05,Included in per diem,5.99,Included in ER Case rate,5.99,5.99, 6.17 ,5.67
Rx76385012301,RX,,76385012301,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHOCARBAMOL TAB 500 MG,1,6.07, 5.77 ,5.95, 5.77 , 5.89 , 5.77 ,Current Medicare Rates,5.89,5.83,Included in per diem,5.77,Included in ER Case rate,5.77,5.77, 5.95 ,5.463
Rx60687055901,RX,,60687055901,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHOCARBAMOL TAB 500 MG,1,6.97, 6.62 ,6.83, 6.62 , 6.76 , 6.62 ,Current Medicare Rates,6.76,6.69,Included in per diem,6.62,Included in ER Case rate,6.62,6.62, 6.83 ,6.273
Rx60687055911,RX,,60687055911,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHOCARBAMOL TAB 500 MG,1,6.86, 6.52 ,6.72, 6.52 , 6.65 , 6.52 ,Current Medicare Rates,6.65,6.59,Included in per diem,6.52,Included in ER Case rate,6.52,6.52, 6.72 ,6.174
Rx51079020001,RX,,51079020001,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHYLDOPA TAB 250 MG,1,7.75, 7.36 ,7.6, 7.36 , 7.52 , 7.36 ,Current Medicare Rates,7.52,7.44,Included in per diem,7.36,Included in ER Case rate,7.36,7.36, 7.60 ,6.975
Rx00781574801,RX,,00781574801,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHYLPHENIDATE HCL TAB 5 MG,1,9.29, 8.83 ,9.1, 8.83 , 9.01 , 8.83 ,Current Medicare Rates,9.01,8.92,Included in per diem,8.83,Included in ER Case rate,8.83,8.83, 9.10 ,8.361
Rx64720023710,RX,,64720023710,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHYLPHENIDATE HCL TAB 5 MG,1,9.26, 8.80 ,9.07, 8.80 , 8.98 , 8.80 ,Current Medicare Rates,8.98,8.89,Included in per diem,8.8,Included in ER Case rate,8.8,8.8, 9.07 ,8.334
Rx68084080511,RX,,68084080511,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHYLPHENIDATE HCL TAB 5 MG,1,13.4, 12.73 ,13.13, 12.73 , 13.00 , 12.73 ,Current Medicare Rates,13,12.86,Included in per diem,12.73,Included in ER Case rate,12.73,12.73, 13.13 ,12.06
Rx51079088801,RX,,51079088801,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739029310,RX,,63739029310,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084067611,RX,,68084067611,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL TAB 10 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739048110,RX,,63739048110,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT),1,6.26, 5.95 ,6.13, 5.95 , 6.07 , 5.95 ,Current Medicare Rates,6.07,6.01,Included in per diem,5.95,Included in ER Case rate,5.95,5.95, 6.13 ,5.634
Rx51079088601,RX,,51079088601,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT),1,8.83, 8.39 ,8.65, 8.39 , 8.57 , 8.39 ,Current Medicare Rates,8.57,8.48,Included in per diem,8.39,Included in ER Case rate,8.39,8.39, 8.65 ,7.947
Rx51079088620,RX,,51079088620,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT),1,9.18, 8.72 ,9, 8.72 , 8.90 , 8.72 ,Current Medicare Rates,8.9,8.81,Included in per diem,8.72,Included in ER Case rate,8.72,8.72, 9.00 ,8.262
Rx63739010310,RX,,63739010310,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL TAB 5 MG (BASE EQUIVALENT),1,6.26, 5.95 ,6.13, 5.95 , 6.07 , 5.95 ,Current Medicare Rates,6.07,6.01,Included in per diem,5.95,Included in ER Case rate,5.95,5.95, 6.13 ,5.634
Rx62584026601,RX,,62584026601,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx62584026611,RX,,62584026611,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00378003201,RX,,00378003201,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00904634161,RX,,00904634161,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOPROLOL TARTRATE TAB 50 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx51079021601,RX,,51079021601,0250 - PHARMACY -  GENERAL CLASSIFICATION,METRONIDAZOLE TAB 250 MG,1,7.61, 7.23 ,7.46, 7.23 , 7.38 , 7.23 ,Current Medicare Rates,7.38,7.31,Included in per diem,7.23,Included in ER Case rate,7.23,7.23, 7.46 ,6.849
Rx00904145361,RX,,00904145361,0250 - PHARMACY -  GENERAL CLASSIFICATION,METRONIDAZOLE TAB 250 MG,1,7.08, 6.73 ,6.94, 6.73 , 6.87 , 6.73 ,Current Medicare Rates,6.87,6.8,Included in per diem,6.73,Included in ER Case rate,6.73,6.73, 6.94 ,6.372
Rx00472073556,RX,,00472073556,0250 - PHARMACY -  GENERAL CLASSIFICATION,MICONAZOLE NITRATE CREAM 2%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx61269073556,RX,,61269073556,0250 - PHARMACY -  GENERAL CLASSIFICATION,MICONAZOLE NITRATE CREAM 2%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx54162019016,RX,,54162019016,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINERAL OIL,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00574061816,RX,,00574061816,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINERAL OIL,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx48433020230,RX,,48433020230,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINERAL OIL,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx17856019004,RX,,17856019004,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINERAL OIL,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00132030140,RX,,00132030140,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINERAL OIL ENEMA,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx68084020411,RX,,68084020411,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINOXIDIL TAB 2.5 MG,1,7.99, 7.59 ,7.83, 7.59 , 7.75 , 7.59 ,Current Medicare Rates,7.75,7.67,Included in per diem,7.59,Included in ER Case rate,7.59,7.59, 7.83 ,7.191
Rx53489038601,RX,,53489038601,0250 - PHARMACY -  GENERAL CLASSIFICATION,MINOXIDIL TAB 2.5 MG,1,6.38, 6.06 ,6.25, 6.06 , 6.19 , 6.06 ,Current Medicare Rates,6.19,6.12,Included in per diem,6.06,Included in ER Case rate,6.06,6.06, 6.25 ,5.742
Rx00054023524,RX,,00054023524,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE TAB 15 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50268059411,RX,,50268059411,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAPROXEN TAB 250 MG,1,7.02, 6.67 ,6.88, 6.67 , 6.81 , 6.67 ,Current Medicare Rates,6.81,6.74,Included in per diem,6.67,Included in ER Case rate,6.67,6.67, 6.88 ,6.318
Rx53746018801,RX,,53746018801,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAPROXEN TAB 250 MG,1,6.03, 5.73 ,5.91, 5.73 , 5.85 , 5.73 ,Current Medicare Rates,5.85,5.79,Included in per diem,5.73,Included in ER Case rate,5.73,5.73, 5.91 ,5.427
Rx39822031005,RX,,39822031005,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN SULFATE TAB 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx39822031007,RX,,39822031007,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN SULFATE TAB 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084002211,RX,,68084002211,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE CAP 10 MG,1,11.77, 11.18 ,11.53, 11.18 , 11.42 , 11.18 ,Current Medicare Rates,11.42,11.3,Included in per diem,11.18,Included in ER Case rate,11.18,11.18, 11.53 ,10.593
Rx50268060011,RX,,50268060011,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE CAP 10 MG,1,13.88, 13.19 ,13.6, 13.19 , 13.46 , 13.19 ,Current Medicare Rates,13.46,13.32,Included in per diem,13.19,Included in ER Case rate,13.19,13.19, 13.60 ,12.492
Rx69315021101,RX,,69315021101,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE CAP 10 MG,1,10.14, 9.63 ,9.94, 9.63 , 9.84 , 9.63 ,Current Medicare Rates,9.84,9.73,Included in per diem,9.63,Included in ER Case rate,9.63,9.63, 9.94 ,9.126
Rx68084007801,RX,,68084007801,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084007811,RX,,68084007811,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MACROCRYSTALLINE CAP 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx52427028601,RX,,52427028601,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MACROCRYSTALLINE CAP 25 MG,1,41.82, 39.73 ,40.98, 39.73 , 40.57 , 39.73 ,Current Medicare Rates,40.57,40.15,Included in per diem,39.73,Included in ER Case rate,39.73,39.73, 40.98 ,37.638
Rx47781030601,RX,,47781030601,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MACROCRYSTALLINE CAP 25 MG,1,14.73, 13.99 ,14.44, 13.99 , 14.29 , 13.99 ,Current Medicare Rates,14.29,14.14,Included in per diem,13.99,Included in ER Case rate,13.99,13.99, 14.44 ,13.257
Rx47781030701,RX,,47781030701,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MACROCRYSTALLINE CAP 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx43598043635,RX,,43598043635,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN SL TAB 0.4 MG,1,0.78, 0.74 ,0.76, 0.74 , 0.76 , 0.74 ,Current Medicare Rates,0.76,0.75,Included in per diem,0.74,Included in ER Case rate,0.74,0.74, 0.76 ,0.702
Rx68462063925,RX,,68462063925,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN SL TAB 0.4 MG,1,0.76, 0.72 ,0.74, 0.72 , 0.74 , 0.72 ,Current Medicare Rates,0.74,0.73,Included in per diem,0.72,Included in ER Case rate,0.72,0.72, 0.74 ,0.684
Rx00071041813,RX,,00071041813,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN SL TAB 0.4 MG,1,1.26, 1.20 ,1.23, 1.20 , 1.22 , 1.20 ,Current Medicare Rates,1.22,1.21,Included in per diem,1.2,Included in ER Case rate,1.2,1.2, 1.23 ,1.134
Rx00281032608,RX,,00281032608,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN OINT 2%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00281032630,RX,,00281032630,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN OINT 2%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx68084003101,RX,,68084003101,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 10 MG,1,7.32, 6.95 ,7.17, 6.95 , 7.10 , 6.95 ,Current Medicare Rates,7.1,7.03,Included in per diem,6.95,Included in ER Case rate,6.95,6.95, 7.17 ,6.588
Rx60687028111,RX,,60687028111,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 10 MG,1,7.14, 6.78 ,7, 6.78 , 6.93 , 6.78 ,Current Medicare Rates,6.93,6.85,Included in per diem,6.78,Included in ER Case rate,6.78,6.78, 7.00 ,6.426
Rx00093081001,RX,,00093081001,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 10 MG,1,6.68, 6.35 ,6.55, 6.35 , 6.48 , 6.35 ,Current Medicare Rates,6.48,6.41,Included in per diem,6.35,Included in ER Case rate,6.35,6.35, 6.55 ,6.012
Rx68084003211,RX,,68084003211,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 25 MG,1,10.66, 10.13 ,10.45, 10.13 , 10.34 , 10.13 ,Current Medicare Rates,10.34,10.23,Included in per diem,10.13,Included in ER Case rate,10.13,10.13, 10.45 ,9.594
Rx50268060411,RX,,50268060411,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 25 MG,1,8.11, 7.70 ,7.95, 7.70 , 7.87 , 7.70 ,Current Medicare Rates,7.87,7.79,Included in per diem,7.7,Included in ER Case rate,7.7,7.7, 7.95 ,7.299
Rx60687029301,RX,,60687029301,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 25 MG,1,7.76, 7.37 ,7.6, 7.37 , 7.53 , 7.37 ,Current Medicare Rates,7.53,7.45,Included in per diem,7.37,Included in ER Case rate,7.37,7.37, 7.60 ,6.984
Rx60687029311,RX,,60687029311,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 25 MG,1,7.77, 7.38 ,7.61, 7.38 , 7.54 , 7.38 ,Current Medicare Rates,7.54,7.46,Included in per diem,7.38,Included in ER Case rate,7.38,7.38, 7.61 ,6.993
Rx00093081101,RX,,00093081101,0250 - PHARMACY -  GENERAL CLASSIFICATION,NORTRIPTYLINE HCL CAP 25 MG,1,7.06, 6.71 ,6.92, 6.71 , 6.85 , 6.71 ,Current Medicare Rates,6.85,6.78,Included in per diem,6.71,Included in ER Case rate,6.71,6.71, 6.92 ,6.354
Rx00168005415,RX,,00168005415,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN CREAM 100000 UNIT/GM,1,59.93, 56.93 ,58.73, 56.93 , 58.13 , 56.93 ,Current Medicare Rates,58.13,57.53,Included in per diem,56.93,Included in ER Case rate,56.93,56.93, 58.73 ,53.937
Rx51672128901,RX,,51672128901,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN CREAM 100000 UNIT/GM,1,37.33, 35.46 ,36.58, 35.46 , 36.21 , 35.46 ,Current Medicare Rates,36.21,35.84,Included in per diem,35.46,Included in ER Case rate,35.46,35.46, 36.58 ,33.597
Rx45802004835,RX,,45802004835,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN OINT 100000 UNIT/GM,1,59.72, 56.73 ,58.53, 56.73 , 57.93 , 56.73 ,Current Medicare Rates,57.93,57.33,Included in per diem,56.73,Included in ER Case rate,56.73,56.73, 58.53 ,53.748
Rx00527512162,RX,,00527512162,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN SUSP 100000 UNIT/ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60432053760,RX,,60432053760,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN SUSP 100000 UNIT/ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx53489040001,RX,,53489040001,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN TAB 500000 UNIT,1,11.16, 10.60 ,10.94, 10.60 , 10.83 , 10.60 ,Current Medicare Rates,10.83,10.71,Included in per diem,10.6,Included in ER Case rate,10.6,10.6, 10.94 ,10.044
Rx00093098301,RX,,00093098301,0250 - PHARMACY -  GENERAL CLASSIFICATION,NYSTATIN TAB 500000 UNIT,1,10.92, 10.37 ,10.7, 10.37 , 10.59 , 10.37 ,Current Medicare Rates,10.59,10.48,Included in per diem,10.37,Included in ER Case rate,10.37,10.37, 10.70 ,9.828
Rx00574030216,RX,,00574030216,0250 - PHARMACY -  GENERAL CLASSIFICATION,ORAL VEHICLES - SYRUP,1,70.15, 66.64 ,68.75, 66.64 , 68.05 , 66.64 ,Current Medicare Rates,68.05,67.34,Included in per diem,66.64,Included in ER Case rate,66.64,66.64, 68.75 ,63.135
Rx68084040011,RX,,68084040011,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYBUTYNIN CHLORIDE TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68308040547,RX,,68308040547,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG,1,8.19, 7.78 ,8.03, 7.78 , 7.94 , 7.78 ,Current Medicare Rates,7.94,7.86,Included in per diem,7.78,Included in ER Case rate,7.78,7.78, 8.03 ,7.371
Rx00406051223,RX,,00406051223,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG,1,7.8, 7.41 ,7.64, 7.41 , 7.57 , 7.41 ,Current Medicare Rates,7.57,7.49,Included in per diem,7.41,Included in ER Case rate,7.41,7.41, 7.64 ,7.02
Rx00904643761,RX,,00904643761,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE W/ ACETAMINOPHEN TAB 5-325 MG,1,7.46, 7.09 ,7.31, 7.09 , 7.24 , 7.09 ,Current Medicare Rates,7.24,7.16,Included in per diem,7.09,Included in ER Case rate,7.09,7.09, 7.31 ,6.714
Rx00904571130,RX,,00904571130,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYMETAZOLINE HCL NASAL SOLN 0.05%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00904676130,RX,,00904676130,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYMETAZOLINE HCL NASAL SOLN 0.05%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00093412573,RX,,00093412573,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENICILLIN V POTASSIUM FOR SOLN 125 MG/5ML,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00093412773,RX,,00093412773,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENICILLIN V POTASSIUM FOR SOLN 250 MG/5ML,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx16714023401,RX,,16714023401,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENICILLIN V POTASSIUM TAB 250 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00781120501,RX,,00781120501,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENICILLIN V POTASSIUM TAB 250 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx57237004001,RX,,57237004001,0250 - PHARMACY -  GENERAL CLASSIFICATION,PENICILLIN V POTASSIUM TAB 250 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx51293080101,RX,,51293080101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENAZOPYRIDINE HCL TAB 100 MG,1,14.72, 13.98 ,14.43, 13.98 , 14.28 , 13.98 ,Current Medicare Rates,14.28,14.13,Included in per diem,13.98,Included in ER Case rate,13.98,13.98, 14.43 ,13.248
Rx42192080101,RX,,42192080101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENAZOPYRIDINE HCL TAB 100 MG,1,6.92, 6.57 ,6.78, 6.57 , 6.71 , 6.57 ,Current Medicare Rates,6.71,6.64,Included in per diem,6.57,Included in ER Case rate,6.57,6.57, 6.78 ,6.228
Rx51293081001,RX,,51293081001,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENAZOPYRIDINE HCL TAB 100 MG,1,7.34, 6.97 ,7.19, 6.97 , 7.12 , 6.97 ,Current Medicare Rates,7.12,7.05,Included in per diem,6.97,Included in ER Case rate,6.97,6.97, 7.19 ,6.606
Rx75826011410,RX,,75826011410,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENAZOPYRIDINE HCL TAB 100 MG,1,9.85, 9.36 ,9.65, 9.36 , 9.55 , 9.36 ,Current Medicare Rates,9.55,9.46,Included in per diem,9.36,Included in ER Case rate,9.36,9.36, 9.65 ,8.865
Rx49348019727,RX,,49348019727,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYLEPHRINE HCL NASAL SOLN 1%,1,19.52, 18.54 ,19.13, 18.54 , 18.93 , 18.54 ,Current Medicare Rates,18.93,18.74,Included in per diem,18.54,Included in ER Case rate,18.54,18.54, 19.13 ,17.568
Rx51672406901,RX,,51672406901,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SUSP 125 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00472500208,RX,,00472500208,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SUSP 125 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx66689077508,RX,,66689077508,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SUSP 125 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx59762053102,RX,,59762053102,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SUSP 125 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68084037601,RX,,68084037601,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SODIUM EXTENDED CAP 100 MG,1,8.47, 8.05 ,8.3, 8.05 , 8.22 , 8.05 ,Current Medicare Rates,8.22,8.13,Included in per diem,8.05,Included in ER Case rate,8.05,8.05, 8.30 ,7.623
Rx68084037611,RX,,68084037611,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SODIUM EXTENDED CAP 100 MG,1,8.47, 8.05 ,8.3, 8.05 , 8.22 , 8.05 ,Current Medicare Rates,8.22,8.13,Included in per diem,8.05,Included in ER Case rate,8.05,8.05, 8.30 ,7.623
Rx00904618761,RX,,00904618761,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SODIUM EXTENDED CAP 100 MG,1,7.79, 7.40 ,7.63, 7.40 , 7.56 , 7.40 ,Current Medicare Rates,7.56,7.48,Included in per diem,7.4,Included in ER Case rate,7.4,7.4, 7.63 ,7.011
Rx51079090501,RX,,51079090501,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENYTOIN SODIUM EXTENDED CAP 100 MG,1,8.4, 7.98 ,8.23, 7.98 , 8.15 , 7.98 ,Current Medicare Rates,8.15,8.06,Included in per diem,7.98,Included in ER Case rate,7.98,7.98, 8.23 ,7.56
Rx58232403401,RX,,58232403401,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN-POLYMYXIN B OINT,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx12547023813,RX,,12547023813,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN-POLYMYXIN B OINT,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx49348027472,RX,,49348027472,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN-POLYMYXIN B OINT,1,27.76, 26.37 ,27.2, 26.37 , 26.93 , 26.37 ,Current Medicare Rates,26.93,26.65,Included in per diem,26.37,Included in ER Case rate,26.37,26.37, 27.20 ,24.984
Rx76439034330,RX,,76439034330,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE POWDER PACKET 20 MEQ,1,22.11, 21.00 ,21.67, 21.00 , 21.45 , 21.00 ,Current Medicare Rates,21.45,21.23,Included in per diem,21,Included in ER Case rate,21,21, 21.67 ,19.899
Rx66758012094,RX,,66758012094,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE POWDER PACKET 20 MEQ,1,41.86, 39.77 ,41.02, 39.77 , 40.60 , 39.77 ,Current Medicare Rates,40.6,40.19,Included in per diem,39.77,Included in ER Case rate,39.77,39.77, 41.02 ,37.674
Rx00603155410,RX,,00603155410,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE POWDER PACKET 20 MEQ,1,30.98, 29.43 ,30.36, 29.43 , 30.05 , 29.43 ,Current Medicare Rates,30.05,29.74,Included in per diem,29.43,Included in ER Case rate,29.43,29.43, 30.36 ,27.882
Rx69543037901,RX,,69543037901,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE POWDER PACKET 20 MEQ,1,14.7, 13.97 ,14.41, 13.97 , 14.26 , 13.97 ,Current Medicare Rates,14.26,14.11,Included in per diem,13.97,Included in ER Case rate,13.97,13.97, 14.41 ,13.23
Rx69238161703,RX,,69238161703,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE POWDER PACKET 20 MEQ,1,14.7, 13.97 ,14.41, 13.97 , 14.26 , 13.97 ,Current Medicare Rates,14.26,14.11,Included in per diem,13.97,Included in ER Case rate,13.97,13.97, 14.41 ,13.23
Rx69238161701,RX,,69238161701,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM CHLORIDE POWDER PACKET 20 MEQ,1,14.75, 14.01 ,14.46, 14.01 , 14.31 , 14.01 ,Current Medicare Rates,14.31,14.16,Included in per diem,14.01,Included in ER Case rate,14.01,14.01, 14.46 ,13.275
Rx00378110101,RX,,00378110101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAZOSIN HCL CAP 1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68084099601,RX,,68084099601,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAZOSIN HCL CAP 1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68084099611,RX,,68084099611,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAZOSIN HCL CAP 1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx51079063001,RX,,51079063001,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAZOSIN HCL CAP 1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00603537221,RX,,00603537221,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRIMIDONE TAB 250 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx68084020311,RX,,68084020311,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRIMIDONE TAB 250 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx50268068411,RX,,50268068411,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT),1,10.57, 10.04 ,10.36, 10.04 , 10.25 , 10.04 ,Current Medicare Rates,10.25,10.15,Included in per diem,10.04,Included in ER Case rate,10.04,10.04, 10.36 ,9.513
Rx51079054101,RX,,51079054101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT),1,9.12, 8.66 ,8.94, 8.66 , 8.85 , 8.66 ,Current Medicare Rates,8.85,8.76,Included in per diem,8.66,Included in ER Case rate,8.66,8.66, 8.94 ,8.208
Rx59746011306,RX,,59746011306,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROCHLORPERAZINE MALEATE TAB 5 MG (BASE EQUIVALENT),1,7.29, 6.93 ,7.14, 6.93 , 7.07 , 6.93 ,Current Medicare Rates,7.07,7,Included in per diem,6.93,Included in ER Case rate,6.93,6.93, 7.14 ,6.561
Rx63739021310,RX,,63739021310,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL TAB 25 MG,1,6.95, 6.60 ,6.81, 6.60 , 6.74 , 6.60 ,Current Medicare Rates,6.74,6.67,Included in per diem,6.6,Included in ER Case rate,6.6,6.6, 6.81 ,6.255
Rx68084015511,RX,,68084015511,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904646161,RX,,00904646161,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx17856080405,RX,,17856080405,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE W/ CODEINE SYRUP 6.25-10 MG/5ML,1,10.53, 10.00 ,10.32, 10.00 , 10.21 , 10.00 ,Current Medicare Rates,10.21,10.11,Included in per diem,10,Included in ER Case rate,10,10, 10.32 ,9.477
Rx00904052361,RX,,00904052361,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASCORBIC ACID TAB 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx23155011101,RX,,23155011101,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROPRANOLOL HCL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00378018301,RX,,00378018301,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROPRANOLOL HCL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687030611,RX,,60687030611,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROPRANOLOL HCL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904670561,RX,,00904670561,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROPRANOLOL HCL TAB 20 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx45802043262,RX,,45802043262,0250 - PHARMACY -  GENERAL CLASSIFICATION,PSEUDOEPHEDRINE HCL TAB 30 MG,1,6.49, 6.17 ,6.36, 6.17 , 6.30 , 6.17 ,Current Medicare Rates,6.3,6.23,Included in per diem,6.17,Included in ER Case rate,6.17,6.17, 6.36 ,5.841
Rx00904699061,RX,,00904699061,0250 - PHARMACY -  GENERAL CLASSIFICATION,PSEUDOEPHEDRINE HCL TAB 30 MG,1,6.34, 6.02 ,6.21, 6.02 , 6.15 , 6.02 ,Current Medicare Rates,6.15,6.09,Included in per diem,6.02,Included in ER Case rate,6.02,6.02, 6.21 ,5.706
Rx50268085811,RX,,50268085811,0250 - PHARMACY -  GENERAL CLASSIFICATION,PYRIDOXINE HCL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00574703412,RX,,00574703412,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASPIRIN SUPPOS 300 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx60258000615,RX,,60258000615,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60258000601,RX,,60258000601,0250 - PHARMACY -  GENERAL CLASSIFICATION,POTASSIUM & SODIUM PHOSPHATES POWDER PACK 280-160-250 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx45802035758,RX,,45802035758,0250 - PHARMACY -  GENERAL CLASSIFICATION,SALINE NASAL SPRAY 0.65%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx51293080301,RX,,51293080301,0250 - PHARMACY -  GENERAL CLASSIFICATION,SALSALATE TAB 500 MG,1,7.24, 6.88 ,7.1, 6.88 , 7.02 , 6.88 ,Current Medicare Rates,7.02,6.95,Included in per diem,6.88,Included in ER Case rate,6.88,6.88, 7.10 ,6.516
Rx51293061501,RX,,51293061501,0250 - PHARMACY -  GENERAL CLASSIFICATION,SALSALATE TAB 500 MG,1,7.23, 6.87 ,7.09, 6.87 , 7.01 , 6.87 ,Current Medicare Rates,7.01,6.94,Included in per diem,6.87,Included in ER Case rate,6.87,6.87, 7.09 ,6.507
Rx00054327099,RX,,00054327099,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT,1,169.95, 161.45 ,166.55, 161.45 , 164.85 , 161.45 ,Current Medicare Rates,164.85,163.15,Included in per diem,161.45,Included in ER Case rate,161.45,161.45, 166.55 ,152.955
Rx60505082901,RX,,60505082901,0250 - PHARMACY -  GENERAL CLASSIFICATION,FLUTICASONE PROPIONATE NASAL SUSP 50 MCG/ACT,1,169.95, 161.45 ,166.55, 161.45 , 164.85 , 161.45 ,Current Medicare Rates,164.85,163.15,Included in per diem,161.45,Included in ER Case rate,161.45,161.45, 166.55 ,152.955
Rx51079075901,RX,,51079075901,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATENOLOL TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx62584046711,RX,,62584046711,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATENOLOL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079068401,RX,,51079068401,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATENOLOL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079068420,RX,,51079068420,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATENOLOL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx67877012425,RX,,67877012425,0250 - PHARMACY -  GENERAL CLASSIFICATION,SILVER SULFADIAZINE CREAM 1%,1,20.3, 19.29 ,19.89, 19.29 , 19.69 , 19.29 ,Current Medicare Rates,19.69,19.49,Included in per diem,19.29,Included in ER Case rate,19.29,19.29, 19.89 ,18.27
Rx43598021055,RX,,43598021055,0250 - PHARMACY -  GENERAL CLASSIFICATION,SILVER SULFADIAZINE CREAM 1%,1,43.33, 41.16 ,42.46, 41.16 , 42.03 , 41.16 ,Current Medicare Rates,42.03,41.6,Included in per diem,41.16,Included in ER Case rate,41.16,41.16, 42.46 ,38.997
Rx43598021025,RX,,43598021025,0250 - PHARMACY -  GENERAL CLASSIFICATION,SILVER SULFADIAZINE CREAM 1%,1,26.99, 25.64 ,26.45, 25.64 , 26.18 , 25.64 ,Current Medicare Rates,26.18,25.91,Included in per diem,25.64,Included in ER Case rate,25.64,25.64, 26.45 ,24.291
Rx00591081046,RX,,00591081046,0250 - PHARMACY -  GENERAL CLASSIFICATION,SILVER SULFADIAZINE CREAM 1%,1,178.8, 169.86 ,175.22, 169.86 , 173.44 , 169.86 ,Current Medicare Rates,173.44,171.65,Included in per diem,169.86,Included in ER Case rate,169.86,169.86, 175.22 ,160.92
Rx61570013125,RX,,61570013125,0250 - PHARMACY -  GENERAL CLASSIFICATION,SILVER SULFADIAZINE CREAM 1%,1,22.99, 21.84 ,22.53, 21.84 , 22.30 , 21.84 ,Current Medicare Rates,22.3,22.07,Included in per diem,21.84,Included in ER Case rate,21.84,21.84, 22.53 ,20.691
Rx63739022510,RX,,63739022510,0250 - PHARMACY -  GENERAL CLASSIFICATION,SIMETHICONE CHEW TAB 80 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx57896079101,RX,,57896079101,0250 - PHARMACY -  GENERAL CLASSIFICATION,SIMETHICONE CHEW TAB 80 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904589430,RX,,00904589430,0250 - PHARMACY -  GENERAL CLASSIFICATION,SIMETHICONE SUSP 40 MG/0.6ML,1,9.68, 9.20 ,9.49, 9.20 , 9.39 , 9.20 ,Current Medicare Rates,9.39,9.29,Included in per diem,9.2,Included in ER Case rate,9.2,9.2, 9.49 ,8.712
Rx66553000801,RX,,66553000801,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE TAB 650 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00536104710,RX,,00536104710,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE TAB 650 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx77333083125,RX,,77333083125,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM BICARBONATE TAB 650 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx24208082555,RX,,24208082555,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATROPINE SULFATE OPHTH OINT 1%,1,74.94, 71.19 ,73.44, 71.19 , 72.69 , 71.19 ,Current Medicare Rates,72.69,71.94,Included in per diem,71.19,Included in ER Case rate,71.19,71.19, 73.44 ,67.446
Rx61314070101,RX,,61314070101,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFACETAMIDE SODIUM OPHTH SOLN 10%,1,148.21, 140.80 ,145.25, 140.80 , 143.76 , 140.80 ,Current Medicare Rates,143.76,142.28,Included in per diem,140.8,Included in ER Case rate,140.8,140.8, 145.25 ,133.389
Rx17478021502,RX,,17478021502,0250 - PHARMACY -  GENERAL CLASSIFICATION,ATROPINE SULFATE OPHTH SOLN 1%,1,145.76, 138.47 ,142.84, 138.47 , 141.39 , 138.47 ,Current Medicare Rates,141.39,139.93,Included in per diem,138.47,Included in ER Case rate,138.47,138.47, 142.84 ,131.184
Rx54162070016,RX,,54162070016,0250 - PHARMACY -  GENERAL CLASSIFICATION,SORBITOL ORAL SOLUTION 70%,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx63739054410,RX,,63739054410,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079010301,RX,,51079010301,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE TAB 25 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079010320,RX,,51079010320,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE TAB 25 MG,1,6.61, 6.28 ,6.48, 6.28 , 6.41 , 6.28 ,Current Medicare Rates,6.41,6.35,Included in per diem,6.28,Included in ER Case rate,6.28,6.28, 6.48 ,5.949
Rx59762501401,RX,,59762501401,0250 - PHARMACY -  GENERAL CLASSIFICATION,SPIRONOLACTONE & HYDROCHLOROTHIAZIDE TAB 25-25 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00000003743,RX,,00000003743,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN 600 MG (ED PREPACK-OR) PO TABS,1,23.99, 22.79 ,23.51, 22.79 , 23.27 , 22.79 ,Current Medicare Rates,23.27,23.03,Included in per diem,22.79,Included in ER Case rate,22.79,22.79, 23.51 ,21.591
Rx00000001575,RX,,00000001575,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT (ED HOMEPACK) IN AERS,1,184.36, 175.14 ,180.67, 175.14 , 178.83 , 175.14 ,Current Medicare Rates,178.83,176.99,Included in per diem,175.14,Included in ER Case rate,175.14,175.14, 180.67 ,165.924
Rx00000003936,RX,,00000003936,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT (ED HOMEPACK) IN AERS,1,169.95, 161.45 ,166.55, 161.45 , 164.85 , 161.45 ,Current Medicare Rates,164.85,163.15,Included in per diem,161.45,Included in ER Case rate,161.45,161.45, 166.55 ,152.955
Rx00000004643,RX,,00000004643,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) FOR SUSP 250 MG/5ML,1,16.76, 15.92 ,16.42, 15.92 , 16.26 , 15.92 ,Current Medicare Rates,16.26,16.09,Included in per diem,15.92,Included in ER Case rate,15.92,15.92, 16.42 ,15.084
Rx00000005083,RX,,00000005083,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML (HOMEPACK) PO SUSR,1,174.84, 166.10 ,171.34, 166.10 , 169.59 , 166.10 ,Current Medicare Rates,169.59,167.85,Included in per diem,166.1,Included in ER Case rate,166.1,166.1, 171.34 ,157.356
Rx00000004644,RX,,00000004644,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 500 MG,1,25.08, 23.83 ,24.58, 23.83 , 24.33 , 23.83 ,Current Medicare Rates,24.33,24.08,Included in per diem,23.83,Included in ER Case rate,23.83,23.83, 24.58 ,22.572
Rx00000001582,RX,,00000001582,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLINDAMYCIN HCL CAP 150 MG,1,48.73, 46.29 ,47.76, 46.29 , 47.27 , 46.29 ,Current Medicare Rates,47.27,46.78,Included in per diem,46.29,Included in ER Case rate,46.29,46.29, 47.76 ,43.857
Rx00000004546,RX,,00000004546,0250 - PHARMACY -  GENERAL CLASSIFICATION,CYCLOBENZAPRINE HCL 10 MG (ED HOMEPACK) PO TABS,1,23.79, 22.60 ,23.31, 22.60 , 23.08 , 22.60 ,Current Medicare Rates,23.08,22.84,Included in per diem,22.6,Included in ER Case rate,22.6,22.6, 23.31 ,21.411
Rx00000001584,RX,,00000001584,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIAZEPAM 5 MG (ED HOMEPACK) PO TABS,1,25.98, 24.68 ,25.46, 24.68 , 25.20 , 24.68 ,Current Medicare Rates,25.2,24.94,Included in per diem,24.68,Included in ER Case rate,24.68,24.68, 25.46 ,23.382
Rx00000001589,RX,,00000001589,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROXYZINE PAMOATE 25 MG  (ED HOMEPACK) PO CAPS,1,25.76, 24.47 ,25.24, 24.47 , 24.99 , 24.47 ,Current Medicare Rates,24.99,24.73,Included in per diem,24.47,Included in ER Case rate,24.47,24.47, 25.24 ,23.184
Rx00000004550,RX,,00000004550,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM 1 MG (ED HOMEPACK) PO TABS,1,25.98, 24.68 ,25.46, 24.68 , 25.20 , 24.68 ,Current Medicare Rates,25.2,24.94,Included in per diem,24.68,Included in ER Case rate,24.68,24.68, 25.46 ,23.382
Rx00000004605,RX,,00000004605,0250 - PHARMACY -  GENERAL CLASSIFICATION,ONDANSETRON ORALLY DISINTEGRATING TAB 4 MG,1,15.96, 15.16 ,15.64, 15.16 , 15.48 , 15.16 ,Current Medicare Rates,15.48,15.32,Included in per diem,15.16,Included in ER Case rate,15.16,15.16, 15.64 ,14.364
Rx00000004841,RX,,00000004841,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL 5 MG (ED HOMEPACK) PO TABS,1,6.91, 6.56 ,6.77, 6.56 , 6.70 , 6.56 ,Current Medicare Rates,6.7,6.63,Included in per diem,6.56,Included in ER Case rate,6.56,6.56, 6.77 ,6.219
Rx00000001596,RX,,00000001596,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE-ACETAMINOPHEN 5-325 MG (ED HOMEPACK) PO TABS,1,28.95, 27.50 ,28.37, 27.50 , 28.08 , 27.50 ,Current Medicare Rates,28.08,27.79,Included in per diem,27.5,Included in ER Case rate,27.5,27.5, 28.37 ,26.055
Rx00000004646,RX,,00000004646,0250 - PHARMACY -  GENERAL CLASSIFICATION,PHENAZOPYRIDINE HCL 100 MG (ED HOMEPACK) PO TABS,1,98.75, 93.81 ,96.78, 93.81 , 95.79 , 93.81 ,Current Medicare Rates,95.79,94.8,Included in per diem,93.81,Included in ER Case rate,93.81,93.81, 96.78 ,88.875
Rx00000004553,RX,,00000004553,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROMETHAZINE HCL 25 MG (ED HOMEPACK) PO TABS,1,23.92, 22.72 ,23.44, 22.72 , 23.20 , 22.72 ,Current Medicare Rates,23.2,22.96,Included in per diem,22.72,Included in ER Case rate,22.72,22.72, 23.44 ,21.528
Rx00000001605,RX,,00000001605,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRAMADOL HCL 50 MG (ED HOMEPACK) PO TABS,1,26.03, 24.73 ,25.51, 24.73 , 25.25 , 24.73 ,Current Medicare Rates,25.25,24.99,Included in per diem,24.73,Included in ER Case rate,24.73,24.73, 25.51 ,23.427
Rx00000001764,RX,,00000001764,0250 - PHARMACY -  GENERAL CLASSIFICATION,METHOCARBAMOL 500 MG (ED HOMEPACK) PO TABS,1,12.15, 11.54 ,11.91, 11.54 , 11.79 , 11.54 ,Current Medicare Rates,11.79,11.66,Included in per diem,11.54,Included in ER Case rate,11.54,11.54, 11.91 ,10.935
Rx00000004533,RX,,00000004533,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN (TRIHYDRATE) CAP 500 MG,1,6.57, 6.24 ,6.44, 6.24 , 6.37 , 6.24 ,Current Medicare Rates,6.37,6.31,Included in per diem,6.24,Included in ER Case rate,6.24,6.24, 6.44 ,5.913
Rx00000004549,RX,,00000004549,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN 800 MG (ED HOMEPACK) PO TABS,1,24.24, 23.03 ,23.76, 23.03 , 23.51 , 23.03 ,Current Medicare Rates,23.51,23.27,Included in per diem,23.03,Included in ER Case rate,23.03,23.03, 23.76 ,21.816
Rx00000001793,RX,,00000001793,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROGLYCERIN 0.4 MG (ED HOMEPACK) SL,1,7.41, 7.04 ,7.26, 7.04 , 7.19 , 7.04 ,Current Medicare Rates,7.19,7.11,Included in per diem,7.04,Included in ER Case rate,7.04,7.04, 7.26 ,6.669
Rx00000004561,RX,,00000004561,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXYCYCLINE HYCLATE 100 MG (ED HOMEPACK) PO TABS,1,80.68, 76.65 ,79.07, 76.65 , 78.26 , 76.65 ,Current Medicare Rates,78.26,77.45,Included in per diem,76.65,Included in ER Case rate,76.65,76.65, 79.07 ,72.612
Rx00000004530,RX,,00000004530,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN 250 MG (ED HOMEPACK) PO TABS,1,24.83, 23.59 ,24.33, 23.59 , 24.09 , 23.59 ,Current Medicare Rates,24.09,23.84,Included in per diem,23.59,Included in ER Case rate,23.59,23.59, 24.33 ,22.347
Rx00000004557,RX,,00000004557,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL TAB 500 MG (BASE EQUIV),1,26.8, 25.46 ,26.26, 25.46 , 26.00 , 25.46 ,Current Medicare Rates,26,25.73,Included in per diem,25.46,Included in ER Case rate,25.46,25.46, 26.26 ,24.12
Rx00000004524,RX,,00000004524,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN TAB 7.5-325 MG,1,27.14, 25.78 ,26.6, 25.78 , 26.33 , 25.78 ,Current Medicare Rates,26.33,26.05,Included in per diem,25.78,Included in ER Case rate,25.78,25.78, 26.60 ,24.426
Rx00000002048,RX,,00000002048,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL 250 MG (ED HOMEPACK) PO TABS,1,25.82, 24.53 ,25.3, 24.53 , 25.05 , 24.53 ,Current Medicare Rates,25.05,24.79,Included in per diem,24.53,Included in ER Case rate,24.53,24.53, 25.30 ,23.238
Rx00000002054,RX,,00000002054,0250 - PHARMACY -  GENERAL CLASSIFICATION,METOCLOPRAMIDE HCL 10 MG (ED HOMEPACK) PO TABS,1,14.93, 14.18 ,14.63, 14.18 , 14.48 , 14.18 ,Current Medicare Rates,14.48,14.33,Included in per diem,14.18,Included in ER Case rate,14.18,14.18, 14.63 ,13.437
Rx00000003932,RX,,00000003932,0250 - PHARMACY -  GENERAL CLASSIFICATION,PANTOPRAZOLE SODIUM 40 MG (ED HOMEPACK) PO TBEC,1,48.11, 45.70 ,47.15, 45.70 , 46.67 , 45.70 ,Current Medicare Rates,46.67,46.19,Included in per diem,45.7,Included in ER Case rate,45.7,45.7, 47.15 ,43.299
Rx00000004541,RX,,00000004541,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN W/ CODEINE SOLN 120-12 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00000001573,RX,,00000001573,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUSP 160 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00000004680,RX,,00000004680,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN 250 MG (ED HOMEPACK) PO CAPS,1,24.06, 22.86 ,23.58, 22.86 , 23.34 , 22.86 ,Current Medicare Rates,23.34,23.1,Included in per diem,22.86,Included in ER Case rate,22.86,22.86, 23.58 ,21.654
Rx00000002068,RX,,00000002068,0250 - PHARMACY -  GENERAL CLASSIFICATION,FUROSEMIDE 40 MG (ED PREPACK) PO TABS,1,11.78, 11.19 ,11.54, 11.19 , 11.43 , 11.19 ,Current Medicare Rates,11.43,11.31,Included in per diem,11.19,Included in ER Case rate,11.19,11.19, 11.54 ,10.602
Rx00000002139,RX,,00000002139,0250 - PHARMACY -  GENERAL CLASSIFICATION,NIFEDIPINE 10 MG (ED HOMEPACK) PO CAPS,1,33.57, 31.89 ,32.9, 31.89 , 32.56 , 31.89 ,Current Medicare Rates,32.56,32.23,Included in per diem,31.89,Included in ER Case rate,31.89,31.89, 32.90 ,30.213
Rx00000004674,RX,,00000004674,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML,1,158.98, 151.03 ,155.8, 151.03 , 154.21 , 151.03 ,Current Medicare Rates,154.21,152.62,Included in per diem,151.03,Included in ER Case rate,151.03,151.03, 155.80 ,143.082
Rx00000004675,RX,,00000004675,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN-POT CLAVULANATE 250-125 MG (ED HOMEPACK) TAB,1,85.19, 80.93 ,83.49, 80.93 , 82.63 , 80.93 ,Current Medicare Rates,82.63,81.78,Included in per diem,80.93,Included in ER Case rate,80.93,80.93, 83.49 ,76.671
Rx00000004677,RX,,00000004677,0250 - PHARMACY -  GENERAL CLASSIFICATION,PROCHLORPERAZINE 5 MG (ED HOMEPACK) PO TABS,1,36.5, 34.68 ,35.77, 34.68 , 35.41 , 34.68 ,Current Medicare Rates,35.41,35.04,Included in per diem,34.68,Included in ER Case rate,34.68,34.68, 35.77 ,32.85
Rx00000001081,RX,,00000001081,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM 0.5 MG (ED HOMEPACK) PO TABS,1,23.74, 22.55 ,23.27, 22.55 , 23.03 , 22.55 ,Current Medicare Rates,23.03,22.79,Included in per diem,22.55,Included in ER Case rate,22.55,22.55, 23.27 ,21.366
Rx00000004679,RX,,00000004679,0250 - PHARMACY -  GENERAL CLASSIFICATION,MECLIZINE HCL 12.5 MG (ED HOMEPACK) PO TABS,1,8.04, 7.64 ,7.88, 7.64 , 7.80 , 7.64 ,Current Medicare Rates,7.8,7.72,Included in per diem,7.64,Included in ER Case rate,7.64,7.64, 7.88 ,7.236
Rx00000004683,RX,,00000004683,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MACROCRYSTAL 50 MG (ED HOMEPACK) PO CAPS,1,48.98, 46.53 ,48, 46.53 , 47.51 , 46.53 ,Current Medicare Rates,47.51,47.02,Included in per diem,46.53,Included in ER Case rate,46.53,46.53, 48.00 ,44.082
Rx00000001084,RX,,00000001084,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIPHENHYDRAMINE HCL 25 MG (ED HOMEPACK) PO CAPS,1,46.67, 44.34 ,45.74, 44.34 , 45.27 , 44.34 ,Current Medicare Rates,45.27,44.8,Included in per diem,44.34,Included in ER Case rate,44.34,44.34, 45.74 ,42.003
Rx00000004696,RX,,00000004696,0250 - PHARMACY -  GENERAL CLASSIFICATION,IBUPROFEN 400 MG (ED HOMEPACK) PO TABS,1,35.61, 33.83 ,34.9, 33.83 , 34.54 , 33.83 ,Current Medicare Rates,34.54,34.19,Included in per diem,33.83,Included in ER Case rate,33.83,33.83, 34.90 ,32.049
Rx00000001148,RX,,00000001148,0250 - PHARMACY -  GENERAL CLASSIFICATION,METRONIDAZOLE 250 MG (ED HOMEPACK) PO TABS,1,30.45, 28.93 ,29.84, 28.93 , 29.54 , 28.93 ,Current Medicare Rates,29.54,29.23,Included in per diem,28.93,Included in ER Case rate,28.93,28.93, 29.84 ,27.405
Rx00000005200,RX,,00000005200,0250 - PHARMACY -  GENERAL CLASSIFICATION,NITROFURANTOIN MONOHYD MACRO 100 MG (ED HOMEPACK) PO CAPS,1,60.56, 57.53 ,59.35, 57.53 , 58.74 , 57.53 ,Current Medicare Rates,58.74,58.14,Included in per diem,57.53,Included in ER Case rate,57.53,57.53, 59.35 ,54.504
Rx00000003823,RX,,00000003823,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZONATATE 100 MG (ED PREPACK) PO CAPS,1,39.19, 37.23 ,38.41, 37.23 , 38.01 , 37.23 ,Current Medicare Rates,38.01,37.62,Included in per diem,37.23,Included in ER Case rate,37.23,37.23, 38.41 ,35.271
Rx00000000726,RX,,00000000726,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM 5 MG (ED PREPACK) PO TABS,1,11.78, 11.19 ,11.54, 11.19 , 11.43 , 11.19 ,Current Medicare Rates,11.43,11.31,Included in per diem,11.19,Included in ER Case rate,11.19,11.19, 11.54 ,10.602
Rx00000004799,RX,,00000004799,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYDROCODONE-ACETAMINOPHEN 10-325 MG (ED HOMEPACK) PO TABS,1,83.17, 79.01 ,81.51, 79.01 , 80.67 , 79.01 ,Current Medicare Rates,80.67,79.84,Included in per diem,79.01,Included in ER Case rate,79.01,79.01, 81.51 ,74.853
Rx00000004975,RX,,00000004975,0250 - PHARMACY -  GENERAL CLASSIFICATION,FAMOTIDINE 20 MG (ED HOMEPACK) PO TABS,1,23.92, 22.72 ,23.44, 22.72 , 23.20 , 22.72 ,Current Medicare Rates,23.2,22.96,Included in per diem,22.72,Included in ER Case rate,22.72,22.72, 23.44 ,21.528
Rx00000005029,RX,,00000005029,0250 - PHARMACY -  GENERAL CLASSIFICATION,NAPROXEN 250 MG (ED HOMEPACK) PO TABS,1,36.05, 34.25 ,35.33, 34.25 , 34.97 , 34.25 ,Current Medicare Rates,34.97,34.61,Included in per diem,34.25,Included in ER Case rate,34.25,34.25, 35.33 ,32.445
Rx00000005096,RX,,00000005096,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUTALBITAL-APAP-CAFFEINE 50-325-40 MG (ED HOMEPACK) PO TABS,1,6.65, 6.32 ,6.52, 6.32 , 6.45 , 6.32 ,Current Medicare Rates,6.45,6.38,Included in per diem,6.32,Included in ER Case rate,6.32,6.32, 6.52 ,5.985
Rx00000005143,RX,,00000005143,0250 - PHARMACY -  GENERAL CLASSIFICATION,KETOROLAC 10 MG (ED HOMEPACK) PO TABS,1,25.69, 24.41 ,25.18, 24.41 , 24.92 , 24.41 ,Current Medicare Rates,24.92,24.66,Included in per diem,24.41,Included in ER Case rate,24.41,24.41, 25.18 ,23.121
Rx00000001088,RX,,00000001088,0250 - PHARMACY -  GENERAL CLASSIFICATION,ONDANSETRON 8 MG (ED PREPACK) PO TBDP,1,119.75, 113.76 ,117.36, 113.76 , 116.16 , 113.76 ,Current Medicare Rates,116.16,114.96,Included in per diem,113.76,Included in ER Case rate,113.76,113.76, 117.36 ,107.775
Rx00000001017,RX,,00000001017,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN 250 MG (ED HOMEPACK) CHEW TAB,1,28.79, 27.35 ,28.21, 27.35 , 27.93 , 27.35 ,Current Medicare Rates,27.93,27.64,Included in per diem,27.35,Included in ER Case rate,27.35,27.35, 28.21 ,25.911
Rx00000001018,RX,,00000001018,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN-POT CLAVULANATE 500-125 MG (ED HOMEPACK) TAB,1,75.83, 72.04 ,74.31, 72.04 , 73.56 , 72.04 ,Current Medicare Rates,73.56,72.8,Included in per diem,72.04,Included in ER Case rate,72.04,72.04, 74.31 ,68.247
Rx00000001019,RX,,00000001019,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONIDINE HCL 0.1 MG (ED HOMEPACK) TAB,1,24.71, 23.47 ,24.22, 23.47 , 23.97 , 23.47 ,Current Medicare Rates,23.97,23.72,Included in per diem,23.47,Included in ER Case rate,23.47,23.47, 24.22 ,22.239
Rx00000001172,RX,,00000001172,0250 - PHARMACY -  GENERAL CLASSIFICATION,LORAZEPAM CONC 2 MG/ML ED PREPACK,1,36.7, 34.87 ,35.97, 34.87 , 35.60 , 34.87 ,Current Medicare Rates,35.6,35.23,Included in per diem,34.87,Included in ER Case rate,34.87,34.87, 35.97 ,33.03
Rx00000001173,RX,,00000001173,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL 100 MG/5ML PO CONC (ED HOMEPACK),1,547.91, 520.51 ,536.95, 520.51 , 531.47 , 520.51 ,Current Medicare Rates,531.47,525.99,Included in per diem,520.51,Included in ER Case rate,520.51,520.51, 536.95 ,493.119
Rx00000001174,RX,,00000001174,0250 - PHARMACY -  GENERAL CLASSIFICATION,MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN (ED HOMEPACK),1,46.16, 43.85 ,45.24, 43.85 , 44.78 , 43.85 ,Current Medicare Rates,44.78,44.31,Included in per diem,43.85,Included in ER Case rate,43.85,43.85, 45.24 ,41.544
Rx00574006915,RX,,00574006915,0250 - PHARMACY -  GENERAL CLASSIFICATION,GLUCOSE GEL 40%,1,6.62, 6.29 ,6.49, 6.29 , 6.42 , 6.29 ,Current Medicare Rates,6.42,6.36,Included in per diem,6.29,Included in ER Case rate,6.29,6.29, 6.49 ,5.958
Rx00000002314,RX,,00000002314,0250 - PHARMACY -  GENERAL CLASSIFICATION,TIZANIDINE HCL 4 MG (ED HOMEPACK) PO TABS,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00000000990,RX,,00000000990,0250 - PHARMACY -  GENERAL CLASSIFICATION,AZITHROMYCIN FOR SUSP 200 MG/5ML (22.5 ML PREPACK),1,343.52, 326.34 ,336.65, 326.34 , 333.21 , 326.34 ,Current Medicare Rates,333.21,329.78,Included in per diem,326.34,Included in ER Case rate,326.34,326.34, 336.65 ,309.168
Rx76329630005,RX,,76329630005,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%",1,98.28, 93.37 ,96.31, 93.37 , 95.33 , 93.37 ,Current Medicare Rates,95.33,94.35,Included in per diem,93.37,Included in ER Case rate,93.37,93.37, 96.31 ,88.452
Rx00054350547,RX,,00054350547,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LIDOCAINE HCL SOLN 4%,LIDOCAINE HCL LARYNGOTRACHEAL SOLN 4%",1,152.23, 144.62 ,149.19, 144.62 , 147.66 , 144.62 ,Current Medicare Rates,147.66,146.14,Included in per diem,144.62,Included in ER Case rate,144.62,144.62, 149.19 ,137.007
Rx17478071130,RX,,17478071130,0250 - PHARMACY -  GENERAL CLASSIFICATION,"LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2%,LIDOCAINE HCL URETHRAL/MUCOSAL GEL PREFILLED SYRINGE 2%",1,242.36, 230.24 ,237.51, 230.24 , 235.09 , 230.24 ,Current Medicare Rates,235.09,232.67,Included in per diem,230.24,Included in ER Case rate,230.24,230.24, 237.51 ,218.124
Rx37864090599,RX,,37864090599,0250 - PHARMACY -  GENERAL CLASSIFICATION,"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG",1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx77333093410,RX,,77333093410,0250 - PHARMACY -  GENERAL CLASSIFICATION,"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG",1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx77333093425,RX,,77333093425,0250 - PHARMACY -  GENERAL CLASSIFICATION,"THIAMINE HCL TAB 100 MG,THIAMINE MONONITRATE TAB 100 MG",1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx50268073015,RX,,50268073015,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFASALAZINE TAB 500 MG,1,7.74, 7.35 ,7.59, 7.35 , 7.51 , 7.35 ,Current Medicare Rates,7.51,7.43,Included in per diem,7.35,Included in ER Case rate,7.35,7.35, 7.59 ,6.966
Rx50268073011,RX,,50268073011,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFASALAZINE TAB 500 MG,1,7.15, 6.79 ,7.01, 6.79 , 6.94 , 6.79 ,Current Medicare Rates,6.94,6.86,Included in per diem,6.79,Included in ER Case rate,6.79,6.79, 7.01 ,6.435
Rx59762500001,RX,,59762500001,0250 - PHARMACY -  GENERAL CLASSIFICATION,SULFASALAZINE TAB 500 MG,1,6.59, 6.26 ,6.46, 6.26 , 6.39 , 6.26 ,Current Medicare Rates,6.39,6.33,Included in per diem,6.26,Included in ER Case rate,6.26,6.26, 6.46 ,5.931
Rx00069046856,RX,,00069046856,0250 - PHARMACY -  GENERAL CLASSIFICATION,VARENICLINE TARTRATE TAB 0.5 MG (BASE EQUIV),1,29.03, 27.58 ,28.45, 27.58 , 28.16 , 27.58 ,Current Medicare Rates,28.16,27.87,Included in per diem,27.58,Included in ER Case rate,27.58,27.58, 28.45 ,26.127
Rx00536333401,RX,,00536333401,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLECALCIFEROL TAB 25 MCG (1000 UNIT),1,5.75, 5.46 ,5.64, 5.46 , 5.58 , 5.46 ,Current Medicare Rates,5.58,5.52,Included in per diem,5.46,Included in ER Case rate,5.46,5.46, 5.64 ,5.175
Rx00904582461,RX,,00904582461,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLECALCIFEROL TAB 25 MCG (1000 UNIT),1,5.85, 5.56 ,5.73, 5.56 , 5.67 , 5.56 ,Current Medicare Rates,5.67,5.62,Included in per diem,5.56,Included in ER Case rate,5.56,5.56, 5.73 ,5.265
Rx79854005023,RX,,79854005023,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLECALCIFEROL TAB 25 MCG (1000 UNIT),1,5.82, 5.53 ,5.7, 5.53 , 5.65 , 5.53 ,Current Medicare Rates,5.65,5.59,Included in per diem,5.53,Included in ER Case rate,5.53,5.53, 5.70 ,5.238
Rx48433010401,RX,,48433010401,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLECALCIFEROL TAB 25 MCG (1000 UNIT),1,6.53, 6.20 ,6.4, 6.20 , 6.33 , 6.20 ,Current Medicare Rates,6.33,6.27,Included in per diem,6.2,Included in ER Case rate,6.2,6.2, 6.40 ,5.877
Rx10006070033,RX,,10006070033,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLECALCIFEROL TAB 25 MCG (1000 UNIT),1,5.85, 5.56 ,5.73, 5.56 , 5.67 , 5.56 ,Current Medicare Rates,5.67,5.62,Included in per diem,5.56,Included in ER Case rate,5.56,5.56, 5.73 ,5.265
Rx80681016800,RX,,80681016800,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLECALCIFEROL TAB 25 MCG (1000 UNIT),1,5.8, 5.51 ,5.68, 5.51 , 5.63 , 5.51 ,Current Medicare Rates,5.63,5.57,Included in per diem,5.51,Included in ER Case rate,5.51,5.51, 5.68 ,5.22
Rx20555003300,RX,,20555003300,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHOLECALCIFEROL TAB 25 MCG (1000 UNIT),1,5.86, 5.57 ,5.74, 5.57 , 5.68 , 5.57 ,Current Medicare Rates,5.68,5.63,Included in per diem,5.57,Included in ER Case rate,5.57,5.57, 5.74 ,5.274
Rx63739026910,RX,,63739026910,0250 - PHARMACY -  GENERAL CLASSIFICATION,TAMOXIFEN CITRATE TAB 10 MG (BASE EQUIVALENT),1,128.75, 122.31 ,126.18, 122.31 , 124.89 , 122.31 ,Current Medicare Rates,124.89,123.6,Included in per diem,122.31,Included in ER Case rate,122.31,122.31, 126.18 ,115.875
Rx00573286820,RX,,00573286820,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAMOX-PE-GLYCERIN-PETROLATUM PERIANAL CREAM 1-0.25-14.4-15%,1,56.25, 53.44 ,55.13, 53.44 , 54.56 , 53.44 ,Current Medicare Rates,54.56,54,Included in per diem,53.44,Included in ER Case rate,53.44,53.44, 55.13 ,50.625
Rx00573286898,RX,,00573286898,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAMOX-PE-GLYCERIN-PETROLATUM PERIANAL CREAM 1-0.25-14.4-15%,1,59.09, 56.14 ,57.91, 56.14 , 57.32 , 56.14 ,Current Medicare Rates,57.32,56.73,Included in per diem,56.14,Included in ER Case rate,56.14,56.14, 57.91 ,53.181
Rx23155001701,RX,,23155001701,0250 - PHARMACY -  GENERAL CLASSIFICATION,TETRACYCLINE HCL CAP 250 MG,1,15.05, 14.30 ,14.75, 14.30 , 14.60 , 14.30 ,Current Medicare Rates,14.6,14.45,Included in per diem,14.3,Included in ER Case rate,14.3,14.3, 14.75 ,13.545
Rx47781050801,RX,,47781050801,0250 - PHARMACY -  GENERAL CLASSIFICATION,TETRACYCLINE HCL CAP 250 MG,1,22.55, 21.42 ,22.1, 21.42 , 21.87 , 21.42 ,Current Medicare Rates,21.87,21.65,Included in per diem,21.42,Included in ER Case rate,21.42,21.42, 22.10 ,20.295
Rx69238152201,RX,,69238152201,0250 - PHARMACY -  GENERAL CLASSIFICATION,TETRACYCLINE HCL CAP 250 MG,1,12.12, 11.51 ,11.88, 11.51 , 11.76 , 11.51 ,Current Medicare Rates,11.76,11.64,Included in per diem,11.51,Included in ER Case rate,11.51,11.51, 11.88 ,10.908
Rx00186404001,RX,,00186404001,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESOMEPRAZOLE MAGNESIUM FOR DELAYED RELEASE SUSP PACKET 40 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx38485086335,RX,,38485086335,0250 - PHARMACY -  GENERAL CLASSIFICATION,ORAL ELECTROLYTE TAB,1,6, 5.70 ,5.88, 5.70 , 5.82 , 5.70 ,Current Medicare Rates,5.82,5.76,Included in per diem,5.7,Included in ER Case rate,5.7,5.7, 5.88 ,5.4
Rx00121177505,RX,,00121177505,0250 - PHARMACY -  GENERAL CLASSIFICATION,GUAIFENESIN-CODEINE SOLN 100-10 MG/5ML,1,31.23, 29.67 ,30.61, 29.67 , 30.29 , 29.67 ,Current Medicare Rates,30.29,29.98,Included in per diem,29.67,Included in ER Case rate,29.67,29.67, 30.61 ,28.107
Rx00456045901,RX,,00456045901,0250 - PHARMACY -  GENERAL CLASSIFICATION,THYROID TAB 60 MG (1 GRAIN),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51672202002,RX,,51672202002,0250 - PHARMACY -  GENERAL CLASSIFICATION,TOLNAFTATE CREAM 1%,1,15.97, 15.17 ,15.65, 15.17 , 15.49 , 15.17 ,Current Medicare Rates,15.49,15.33,Included in per diem,15.17,Included in ER Case rate,15.17,15.17, 15.65 ,14.373
Rx00904655461,RX,,00904655461,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRAZODONE HCL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904686861,RX,,00904686861,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRAZODONE HCL TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00168000415,RX,,00168000415,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMCINOLONE ACETONIDE CREAM 0.1%,1,15.72, 14.93 ,15.41, 14.93 , 15.25 , 14.93 ,Current Medicare Rates,15.25,15.09,Included in per diem,14.93,Included in ER Case rate,14.93,14.93, 15.41 ,14.148
Rx45802006435,RX,,45802006435,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMCINOLONE ACETONIDE CREAM 0.1%,1,16.91, 16.06 ,16.57, 16.06 , 16.40 , 16.06 ,Current Medicare Rates,16.4,16.23,Included in per diem,16.06,Included in ER Case rate,16.06,16.06, 16.57 ,15.219
Rx00168000615,RX,,00168000615,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMCINOLONE ACETONIDE OINT 0.1%,1,21.06, 20.01 ,20.64, 20.01 , 20.43 , 20.01 ,Current Medicare Rates,20.43,20.22,Included in per diem,20.01,Included in ER Case rate,20.01,20.01, 20.64 ,18.954
Rx45802005535,RX,,45802005535,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMCINOLONE ACETONIDE OINT 0.1%,1,20.4, 19.38 ,19.99, 19.38 , 19.79 , 19.38 ,Current Medicare Rates,19.79,19.58,Included in per diem,19.38,Included in ER Case rate,19.38,19.38, 19.99 ,18.36
Rx45802004935,RX,,45802004935,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMCINOLONE ACETONIDE OINT 0.5%,1,19.59, 18.61 ,19.2, 18.61 , 19.00 , 18.61 ,Current Medicare Rates,19,18.81,Included in per diem,18.61,Included in ER Case rate,18.61,18.61, 19.20 ,17.631
Rx51672126705,RX,,51672126705,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMCINOLONE ACETONIDE DENTAL PASTE 0.1%,1,213.81, 203.12 ,209.53, 203.12 , 207.40 , 203.12 ,Current Medicare Rates,207.4,205.26,Included in per diem,203.12,Included in ER Case rate,203.12,203.12, 209.53 ,192.429
Rx68084075025,RX,,68084075025,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG,1,9.13, 8.67 ,8.95, 8.67 , 8.86 , 8.67 ,Current Medicare Rates,8.86,8.76,Included in per diem,8.67,Included in ER Case rate,8.67,8.67, 8.95 ,8.217
Rx68084075095,RX,,68084075095,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMTERENE & HYDROCHLOROTHIAZIDE TAB 37.5-25 MG,1,9.14, 8.68 ,8.96, 8.68 , 8.87 , 8.68 ,Current Medicare Rates,8.87,8.77,Included in per diem,8.68,Included in ER Case rate,8.68,8.68, 8.96 ,8.226
Rx51079076701,RX,,51079076701,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB ER 24 HR 500 MG,1,16, 15.20 ,15.68, 15.20 , 15.52 , 15.20 ,Current Medicare Rates,15.52,15.36,Included in per diem,15.2,Included in ER Case rate,15.2,15.2, 15.68 ,14.4
Rx00904636445,RX,,00904636445,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIVALPROEX SODIUM TAB ER 24 HR 500 MG,1,16.86, 16.02 ,16.52, 16.02 , 16.35 , 16.02 ,Current Medicare Rates,16.35,16.19,Included in per diem,16.02,Included in ER Case rate,16.02,16.02, 16.52 ,15.174
Rx00186037228,RX,,00186037228,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 80-4.5 MCG/ACT,1,179.84, 170.85 ,176.24, 170.85 , 174.44 , 170.85 ,Current Medicare Rates,174.44,172.65,Included in per diem,170.85,Included in ER Case rate,170.85,170.85, 176.24 ,161.856
Rx00186037028,RX,,00186037028,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUDESONIDE-FORMOTEROL FUMARATE DIHYD AEROSOL 160-4.5 MCG/ACT,1,179.85, 170.86 ,176.25, 170.86 , 174.45 , 170.86 ,Current Medicare Rates,174.45,172.66,Included in per diem,170.86,Included in ER Case rate,170.86,170.86, 176.25 ,161.865
Rx00591533501,RX,,00591533501,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIHEXYPHENIDYL HCL TAB 2 MG,1,6.45, 6.13 ,6.32, 6.13 , 6.26 , 6.13 ,Current Medicare Rates,6.26,6.19,Included in per diem,6.13,Included in ER Case rate,6.13,6.13, 6.32 ,5.805
Rx00536111411,RX,,00536111411,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 1 MG,1,5.77, 5.48 ,5.65, 5.48 , 5.60 , 5.48 ,Current Medicare Rates,5.6,5.54,Included in per diem,5.48,Included in ER Case rate,5.48,5.48, 5.65 ,5.193
Rx10006073051,RX,,10006073051,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 1 MG,1,5.77, 5.48 ,5.65, 5.48 , 5.60 , 5.48 ,Current Medicare Rates,5.6,5.54,Included in per diem,5.48,Included in ER Case rate,5.48,5.48, 5.65 ,5.193
Rx80681004100,RX,,80681004100,0250 - PHARMACY -  GENERAL CLASSIFICATION,MELATONIN TAB 1 MG,1,5.74, 5.45 ,5.63, 5.45 , 5.57 , 5.45 ,Current Medicare Rates,5.57,5.51,Included in per diem,5.45,Included in ER Case rate,5.45,5.45, 5.63 ,5.166
Rx24208058564,RX,,24208058564,0250 - PHARMACY -  GENERAL CLASSIFICATION,TROPICAMIDE OPHTH SOLN 1%,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
Rx61314035502,RX,,61314035502,0250 - PHARMACY -  GENERAL CLASSIFICATION,TROPICAMIDE OPHTH SOLN 1%,1,116.49, 110.67 ,114.16, 110.67 , 113.00 , 110.67 ,Current Medicare Rates,113,111.83,Included in per diem,110.67,Included in ER Case rate,110.67,110.67, 114.16 ,104.841
Rx00603184158,RX,,00603184158,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50383079216,RX,,50383079216,0250 - PHARMACY -  GENERAL CLASSIFICATION,VALPROATE SODIUM ORAL SOLN 250 MG/5ML (BASE EQUIV),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx45802006070,RX,,45802006070,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACITRACIN OINT 500 UNIT/GM,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00591040401,RX,,00591040401,0250 - PHARMACY -  GENERAL CLASSIFICATION,VERAPAMIL HCL TAB 40 MG,1,6.48, 6.16 ,6.35, 6.16 , 6.29 , 6.16 ,Current Medicare Rates,6.29,6.22,Included in per diem,6.16,Included in ER Case rate,6.16,6.16, 6.35 ,5.832
Rx00168001209,RX,,00168001209,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-BACITRACIN-POLYMYXIN OINT,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx45802006170,RX,,45802006170,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-BACITRACIN-POLYMYXIN OINT,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx51672201602,RX,,51672201602,0250 - PHARMACY -  GENERAL CLASSIFICATION,NEOMYCIN-BACITRACIN-POLYMYXIN OINT,1,27.9, 26.51 ,27.34, 26.51 , 27.06 , 26.51 ,Current Medicare Rates,27.06,26.78,Included in per diem,26.51,Included in ER Case rate,26.51,26.51, 27.34 ,25.11
Rx63739047910,RX,,63739047910,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACLOFEN TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084085501,RX,,68084085501,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACLOFEN TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084085511,RX,,68084085511,0250 - PHARMACY -  GENERAL CLASSIFICATION,BACLOFEN TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx43292055540,RX,,43292055540,0250 - PHARMACY -  GENERAL CLASSIFICATION,B-COMPLEX VITAMIN TAB,1,5.78, 5.49 ,5.66, 5.49 , 5.61 , 5.49 ,Current Medicare Rates,5.61,5.55,Included in per diem,5.49,Included in ER Case rate,5.49,5.49, 5.66 ,5.202
Rx54162000002,RX,,54162000002,0250 - PHARMACY -  GENERAL CLASSIFICATION,VITAMINS A & D OINT,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00832121201,RX,,00832121201,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 2 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00056017001,RX,,00056017001,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 2 MG,1,16.93, 16.08 ,16.59, 16.08 , 16.42 , 16.08 ,Current Medicare Rates,16.42,16.25,Included in per diem,16.08,Included in ER Case rate,16.08,16.08, 16.59 ,15.237
Rx00832121289,RX,,00832121289,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 2 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00832121301,RX,,00832121301,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 2.5 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00056017601,RX,,00056017601,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 2.5 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00832121389,RX,,00832121389,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 2.5 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00832121601,RX,,00832121601,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00056017201,RX,,00056017201,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 5 MG,1,17.78, 16.89 ,17.42, 16.89 , 17.25 , 16.89 ,Current Medicare Rates,17.25,17.07,Included in per diem,16.89,Included in ER Case rate,16.89,16.89, 17.42 ,16.002
Rx00832121689,RX,,00832121689,0250 - PHARMACY -  GENERAL CLASSIFICATION,WARFARIN SODIUM TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084004811,RX,,68084004811,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 10 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68084096801,RX,,68084096801,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 10 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx68084096811,RX,,68084096811,0250 - PHARMACY -  GENERAL CLASSIFICATION,OXYCODONE HCL TAB 10 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00187065820,RX,,00187065820,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIAZEPAM RECTAL GEL DELIVERY SYSTEM 10 MG,1,272.28, 258.67 ,266.83, 258.67 , 264.11 , 258.67 ,Current Medicare Rates,264.11,261.39,Included in per diem,258.67,Included in ER Case rate,258.67,258.67, 266.83 ,245.052
Rx00006022761,RX,,00006022761,0250 - PHARMACY -  GENERAL CLASSIFICATION,RALTEGRAVIR POTASSIUM TAB 400 MG (BASE EQUIV),1,82.56, 78.43 ,80.91, 78.43 , 80.08 , 78.43 ,Current Medicare Rates,80.08,79.26,Included in per diem,78.43,Included in ER Case rate,78.43,78.43, 80.91 ,74.304
Rx63739003807,RX,,63739003807,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV),1,37.1, 35.25 ,36.36, 35.25 , 35.99 , 35.25 ,Current Medicare Rates,35.99,35.62,Included in per diem,35.25,Included in ER Case rate,35.25,35.25, 36.36 ,33.39
Rx64380079701,RX,,64380079701,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV),1,28.38, 26.96 ,27.81, 26.96 , 27.53 , 26.96 ,Current Medicare Rates,27.53,27.24,Included in per diem,26.96,Included in ER Case rate,26.96,26.96, 27.81 ,25.542
Rx16714081701,RX,,16714081701,0250 - PHARMACY -  GENERAL CLASSIFICATION,OSELTAMIVIR PHOSPHATE CAP 30 MG (BASE EQUIV),1,21.64, 20.56 ,21.21, 20.56 , 20.99 , 20.56 ,Current Medicare Rates,20.99,20.77,Included in per diem,20.56,Included in ER Case rate,20.56,20.56, 21.21 ,19.476
Rx00168006231,RX,,00168006231,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZINC OXIDE OINT 20%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx00536570028,RX,,00536570028,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZINC OXIDE OINT 20%,1,15.45, 14.68 ,15.14, 14.68 , 14.99 , 14.68 ,Current Medicare Rates,14.99,14.83,Included in per diem,14.68,Included in ER Case rate,14.68,14.68, 15.14 ,13.905
Rx77333098310,RX,,77333098310,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN),1,6.49, 6.17 ,6.36, 6.17 , 6.30 , 6.17 ,Current Medicare Rates,6.3,6.23,Included in per diem,6.17,Included in ER Case rate,6.17,6.17, 6.36 ,5.841
Rx77333098325,RX,,77333098325,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZINC SULFATE CAP 220 MG (50 MG ELEMENTAL ZN),1,6.45, 6.13 ,6.32, 6.13 , 6.26 , 6.13 ,Current Medicare Rates,6.26,6.19,Included in per diem,6.13,Included in ER Case rate,6.13,6.13, 6.32 ,5.805
Rx00065054301,RX,,00065054301,0250 - PHARMACY -  GENERAL CLASSIFICATION,TRIAMCINOLONE ACETONIDE OPHTH INJ 40 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx45802020326,RX,,45802020326,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUSP 160 MG/5ML,1,12.7, 12.07 ,12.45, 12.07 , 12.32 , 12.07 ,Current Medicare Rates,12.32,12.19,Included in per diem,12.07,Included in ER Case rate,12.07,12.07, 12.45 ,11.43
Rx00121178105,RX,,00121178105,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUSP 160 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00121178100,RX,,00121178100,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACETAMINOPHEN SUSP 160 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00603254421,RX,,00603254421,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG,1,12.06, 11.46 ,11.82, 11.46 , 11.70 , 11.46 ,Current Medicare Rates,11.7,11.58,Included in per diem,11.46,Included in ER Case rate,11.46,11.46, 11.82 ,10.854
Rx00591336901,RX,,00591336901,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG,1,9.67, 9.19 ,9.48, 9.19 , 9.38 , 9.19 ,Current Medicare Rates,9.38,9.28,Included in per diem,9.19,Included in ER Case rate,9.19,9.19, 9.48 ,8.703
Rx68084039611,RX,,68084039611,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG,1,14.71, 13.97 ,14.42, 13.97 , 14.27 , 13.97 ,Current Medicare Rates,14.27,14.12,Included in per diem,13.97,Included in ER Case rate,13.97,13.97, 14.42 ,13.239
Rx68084039665,RX,,68084039665,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUTALBITAL-ACETAMINOPHEN-CAFFEINE TAB 50-325-40 MG,1,14.68, 13.95 ,14.39, 13.95 , 14.24 , 13.95 ,Current Medicare Rates,14.24,14.09,Included in per diem,13.95,Included in ER Case rate,13.95,13.95, 14.39 ,13.212
Rx00904578961,RX,,00904578961,0250 - PHARMACY -  GENERAL CLASSIFICATION,ACYCLOVIR CAP 200 MG,1,6.34, 6.02 ,6.21, 6.02 , 6.15 , 6.02 ,Current Medicare Rates,6.15,6.09,Included in per diem,6.02,Included in ER Case rate,6.02,6.02, 6.21 ,5.706
Rx64980033901,RX,,64980033901,0250 - PHARMACY -  GENERAL CLASSIFICATION,MAGNESIUM OXIDE TAB 400 MG (241.3 MG ELEMENTAL MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx64980033990,RX,,64980033990,0250 - PHARMACY -  GENERAL CLASSIFICATION,MAGNESIUM OXIDE TAB 400 MG (241.3 MG ELEMENTAL MG),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00121176130,RX,,00121176130,0250 - PHARMACY -  GENERAL CLASSIFICATION,ALUM & MAG HYDROXIDE-SIMETHICONE SUSP 200-200-20 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00245014701,RX,,00245014701,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMIODARONE HCL TAB 200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739038710,RX,,63739038710,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMIODARONE HCL TAB 200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00245014789,RX,,00245014789,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMIODARONE HCL TAB 200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084037111,RX,,68084037111,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMIODARONE HCL TAB 200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904655661,RX,,00904655661,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMIODARONE HCL TAB 200 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079045101,RX,,51079045101,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT),1,6.03, 5.73 ,5.91, 5.73 , 5.85 , 5.73 ,Current Medicare Rates,5.85,5.79,Included in per diem,5.73,Included in ER Case rate,5.73,5.73, 5.91 ,5.427
Rx00904637061,RX,,00904637061,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMLODIPINE BESYLATE TAB 5 MG (BASE EQUIVALENT),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx43598001251,RX,,43598001251,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 125-31.25 MG/5ML,1,106.95, 101.60 ,104.81, 101.60 , 103.74 , 101.60 ,Current Medicare Rates,103.74,102.67,Included in per diem,101.6,Included in ER Case rate,101.6,101.6, 104.81 ,96.255
Rx60432006575,RX,,60432006575,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML,1,8.72, 8.28 ,8.55, 8.28 , 8.46 , 8.28 ,Current Medicare Rates,8.46,8.37,Included in per diem,8.28,Included in ER Case rate,8.28,8.28, 8.55 ,7.848
Rx43598020451,RX,,43598020451,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML,1,13.51, 12.83 ,13.24, 12.83 , 13.10 , 12.83 ,Current Medicare Rates,13.1,12.97,Included in per diem,12.83,Included in ER Case rate,12.83,12.83, 13.24 ,12.159
Rx72508020407,RX,,72508020407,0250 - PHARMACY -  GENERAL CLASSIFICATION,AMOXICILLIN & K CLAVULANATE FOR SUSP 250-62.5 MG/5ML,1,25.88, 24.59 ,25.36, 24.59 , 25.10 , 24.59 ,Current Medicare Rates,25.1,24.84,Included in per diem,24.59,Included in ER Case rate,24.59,24.59, 25.36 ,23.292
Rx08137003690,RX,,08137003690,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRAMOXINE-CALAMINE LOTION 1-3%,1,22.51, 21.38 ,22.06, 21.38 , 21.83 , 21.38 ,Current Medicare Rates,21.83,21.61,Included in per diem,21.38,Included in ER Case rate,21.38,21.38, 22.06 ,20.259
Rx00078042947,RX,,00078042947,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYPROMELLOSE OPHTH GEL 0.3%,1,37.91, 36.01 ,37.15, 36.01 , 36.77 , 36.01 ,Current Medicare Rates,36.77,36.39,Included in per diem,36.01,Included in ER Case rate,36.01,36.01, 37.15 ,34.119
Rx00065047401,RX,,00065047401,0250 - PHARMACY -  GENERAL CLASSIFICATION,HYPROMELLOSE OPHTH GEL 0.3%,1,52.51, 49.88 ,51.46, 49.88 , 50.93 , 49.88 ,Current Medicare Rates,50.93,50.41,Included in per diem,49.88,Included in ER Case rate,49.88,49.88, 51.46 ,47.259
Rx00904513559,RX,,00904513559,0250 - PHARMACY -  GENERAL CLASSIFICATION,ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB 250-250-65 MG,1,5.77, 5.48 ,5.65, 5.48 , 5.60 , 5.48 ,Current Medicare Rates,5.6,5.54,Included in per diem,5.48,Included in ER Case rate,5.48,5.48, 5.65 ,5.193
Rx00085146102,RX,,00085146102,0250 - PHARMACY -  GENERAL CLASSIFICATION,MOMETASONE FUROATE INHAL POWD 110 MCG/INH (BREATH ACTIVATED),1,474.77, 451.03 ,465.27, 451.03 , 460.53 , 451.03 ,Current Medicare Rates,460.53,455.78,Included in per diem,451.03,Included in ER Case rate,451.03,451.03, 465.27 ,427.293
Rx51079014501,RX,,51079014501,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENAZEPRIL HCL TAB 10 MG,1,6.17, 5.86 ,6.05, 5.86 , 5.98 , 5.86 ,Current Medicare Rates,5.98,5.92,Included in per diem,5.86,Included in ER Case rate,5.86,5.86, 6.05 ,5.553
Rx43547033610,RX,,43547033610,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENAZEPRIL HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx74300000301,RX,,74300000301,0250 - PHARMACY -  GENERAL CLASSIFICATION,ZINC OXIDE CREAM 13%,1,27.23, 25.87 ,26.69, 25.87 , 26.41 , 25.87 ,Current Medicare Rates,26.41,26.14,Included in per diem,25.87,Included in ER Case rate,25.87,25.87, 26.69 ,24.507
Rx00093423301,RX,,00093423301,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUMETANIDE TAB 1 MG,1,9.35, 8.88 ,9.16, 8.88 , 9.07 , 8.88 ,Current Medicare Rates,9.07,8.98,Included in per diem,8.88,Included in ER Case rate,8.88,8.88, 9.16 ,8.415
Rx42799012001,RX,,42799012001,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUMETANIDE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687038425,RX,,60687038425,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUMETANIDE TAB 1 MG,1,7.1, 6.75 ,6.96, 6.75 , 6.89 , 6.75 ,Current Medicare Rates,6.89,6.82,Included in per diem,6.75,Included in ER Case rate,6.75,6.75, 6.96 ,6.39
Rx60687038495,RX,,60687038495,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUMETANIDE TAB 1 MG,1,6.52, 6.19 ,6.39, 6.19 , 6.32 , 6.19 ,Current Medicare Rates,6.32,6.26,Included in per diem,6.19,Included in ER Case rate,6.19,6.19, 6.39 ,5.868
Rx00781106401,RX,,00781106401,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPROPION HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687035101,RX,,60687035101,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPROPION HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687035111,RX,,60687035111,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPROPION HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904663661,RX,,00904663661,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPROPION HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079094401,RX,,51079094401,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUPROPION HCL TAB 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079098501,RX,,51079098501,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUSPIRONE HCL TAB 5 MG,1,6.15, 5.84 ,6.03, 5.84 , 5.97 , 5.84 ,Current Medicare Rates,5.97,5.9,Included in per diem,5.84,Included in ER Case rate,5.84,5.84, 6.03 ,5.535
Rx00093005301,RX,,00093005301,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUSPIRONE HCL TAB 5 MG,1,5.94, 5.64 ,5.82, 5.64 , 5.76 , 5.64 ,Current Medicare Rates,5.76,5.7,Included in per diem,5.64,Included in ER Case rate,5.64,5.64, 5.82 ,5.346
Rx00054000713,RX,,00054000713,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCITRIOL CAP 0.25 MCG,1,9.89, 9.40 ,9.69, 9.40 , 9.59 , 9.40 ,Current Medicare Rates,9.59,9.49,Included in per diem,9.4,Included in ER Case rate,9.4,9.4, 9.69 ,8.901
Rx23155011803,RX,,23155011803,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCITRIOL CAP 0.25 MCG,1,7.31, 6.94 ,7.16, 6.94 , 7.09 , 6.94 ,Current Medicare Rates,7.09,7.02,Included in per diem,6.94,Included in ER Case rate,6.94,6.94, 7.16 ,6.579
Rx60687034501,RX,,60687034501,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCITRIOL CAP 0.25 MCG,1,8.54, 8.11 ,8.37, 8.11 , 8.28 , 8.11 ,Current Medicare Rates,8.28,8.2,Included in per diem,8.11,Included in ER Case rate,8.11,8.11, 8.37 ,7.686
Rx60687034511,RX,,60687034511,0250 - PHARMACY -  GENERAL CLASSIFICATION,CALCITRIOL CAP 0.25 MCG,1,8.2, 7.79 ,8.04, 7.79 , 7.95 , 7.79 ,Current Medicare Rates,7.95,7.87,Included in per diem,7.79,Included in ER Case rate,7.79,7.79, 8.04 ,7.38
Rx46287050001,RX,,46287050001,0250 - PHARMACY -  GENERAL CLASSIFICATION,SORBITOL SOLUTION (BULK),1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00536111825,RX,,00536111825,0250 - PHARMACY -  GENERAL CLASSIFICATION,CAPSAICIN CREAM 0.075%,1,18.96, 18.01 ,18.58, 18.01 , 18.39 , 18.01 ,Current Medicare Rates,18.39,18.2,Included in per diem,18.01,Included in ER Case rate,18.01,18.01, 18.58 ,17.064
Rx00143117101,RX,,00143117101,0250 - PHARMACY -  GENERAL CLASSIFICATION,CAPTOPRIL TAB 12.5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079086301,RX,,51079086301,0250 - PHARMACY -  GENERAL CLASSIFICATION,CAPTOPRIL TAB 12.5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904504561,RX,,00904504561,0250 - PHARMACY -  GENERAL CLASSIFICATION,CAPTOPRIL TAB 12.5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00228253810,RX,,00228253810,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 10-100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739004610,RX,,63739004610,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 10-100 MG,1,6.68, 6.35 ,6.55, 6.35 , 6.48 , 6.35 ,Current Medicare Rates,6.48,6.41,Included in per diem,6.35,Included in ER Case rate,6.35,6.35, 6.55 ,6.012
Rx62756051788,RX,,62756051788,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 10-100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx63739010710,RX,,63739010710,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 10-100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084009301,RX,,68084009301,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 25-100 MG,1,6.87, 6.53 ,6.73, 6.53 , 6.66 , 6.53 ,Current Medicare Rates,6.66,6.6,Included in per diem,6.53,Included in ER Case rate,6.53,6.53, 6.73 ,6.183
Rx63739004710,RX,,63739004710,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 25-100 MG,1,6.67, 6.34 ,6.54, 6.34 , 6.47 , 6.34 ,Current Medicare Rates,6.47,6.4,Included in per diem,6.34,Included in ER Case rate,6.34,6.34, 6.54 ,6.003
Rx00904623761,RX,,00904623761,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 25-100 MG,1,6.45, 6.13 ,6.32, 6.13 , 6.26 , 6.13 ,Current Medicare Rates,6.26,6.19,Included in per diem,6.13,Included in ER Case rate,6.13,6.13, 6.32 ,5.805
Rx63739004810,RX,,63739004810,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 25-250 MG,1,6.91, 6.56 ,6.77, 6.56 , 6.70 , 6.56 ,Current Medicare Rates,6.7,6.63,Included in per diem,6.56,Included in ER Case rate,6.56,6.56, 6.77 ,6.219
Rx00904623861,RX,,00904623861,0250 - PHARMACY -  GENERAL CLASSIFICATION,CARBIDOPA & LEVODOPA TAB 25-250 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904625549,RX,,00904625549,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZOCAINE-MENTHOL LOZENGE 15-3.6 MG,1,6.11, 5.80 ,5.99, 5.80 , 5.93 , 5.80 ,Current Medicare Rates,5.93,5.87,Included in per diem,5.8,Included in ER Case rate,5.8,5.8, 5.99 ,5.499
Rx16714040301,RX,,16714040301,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFPODOXIME PROXETIL FOR SUSP 100 MG/5ML,1,39.93, 37.93 ,39.13, 37.93 , 38.73 , 37.93 ,Current Medicare Rates,38.73,38.33,Included in per diem,37.93,Included in ER Case rate,37.93,37.93, 39.13 ,35.937
Rx00781543920,RX,,00781543920,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFPODOXIME PROXETIL TAB 200 MG,1,12.07, 11.47 ,11.83, 11.47 , 11.71 , 11.47 ,Current Medicare Rates,11.71,11.59,Included in per diem,11.47,Included in ER Case rate,11.47,11.47, 11.83 ,10.863
Rx16714039501,RX,,16714039501,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFPODOXIME PROXETIL TAB 200 MG,1,9.67, 9.19 ,9.48, 9.19 , 9.38 , 9.19 ,Current Medicare Rates,9.38,9.28,Included in per diem,9.19,Included in ER Case rate,9.19,9.19, 9.48 ,8.703
Rx65862069920,RX,,65862069920,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFUROXIME AXETIL TAB 250 MG,1,7.89, 7.50 ,7.73, 7.50 , 7.65 , 7.50 ,Current Medicare Rates,7.65,7.57,Included in per diem,7.5,Included in ER Case rate,7.5,7.5, 7.73 ,7.101
Rx16714040001,RX,,16714040001,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFUROXIME AXETIL TAB 250 MG,1,13.81, 13.12 ,13.53, 13.12 , 13.40 , 13.12 ,Current Medicare Rates,13.4,13.26,Included in per diem,13.12,Included in ER Case rate,13.12,13.12, 13.53 ,12.429
Rx60687027211,RX,,60687027211,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEFUROXIME AXETIL TAB 250 MG,1,22.59, 21.46 ,22.14, 21.46 , 21.91 , 21.46 ,Current Medicare Rates,21.91,21.69,Included in per diem,21.46,Included in ER Case rate,21.46,21.46, 22.14 ,20.331
Rx65862001801,RX,,65862001801,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 250 MG,1,6.24, 5.93 ,6.12, 5.93 , 6.05 , 5.93 ,Current Medicare Rates,6.05,5.99,Included in per diem,5.93,Included in ER Case rate,5.93,5.93, 6.12 ,5.616
Rx50268015111,RX,,50268015111,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 250 MG,1,7.77, 7.38 ,7.61, 7.38 , 7.54 , 7.38 ,Current Medicare Rates,7.54,7.46,Included in per diem,7.38,Included in ER Case rate,7.38,7.38, 7.61 ,6.993
Rx60687015201,RX,,60687015201,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 250 MG,1,7.24, 6.88 ,7.1, 6.88 , 7.02 , 6.88 ,Current Medicare Rates,7.02,6.95,Included in per diem,6.88,Included in ER Case rate,6.88,6.88, 7.10 ,6.516
Rx60687015211,RX,,60687015211,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 250 MG,1,7.36, 6.99 ,7.21, 6.99 , 7.14 , 6.99 ,Current Medicare Rates,7.14,7.07,Included in per diem,6.99,Included in ER Case rate,6.99,6.99, 7.21 ,6.624
Rx50268015211,RX,,50268015211,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687016311,RX,,60687016311,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093314701,RX,,00093314701,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN CAP 500 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093417573,RX,,00093417573,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN FOR SUSP 125 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx00093417773,RX,,00093417773,0250 - PHARMACY -  GENERAL CLASSIFICATION,CEPHALEXIN FOR SUSP 250 MG/5ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx51079059701,RX,,51079059701,0250 - PHARMACY -  GENERAL CLASSIFICATION,CETIRIZINE HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079059720,RX,,51079059720,0250 - PHARMACY -  GENERAL CLASSIFICATION,CETIRIZINE HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx45802091939,RX,,45802091939,0250 - PHARMACY -  GENERAL CLASSIFICATION,CETIRIZINE HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00904671761,RX,,00904671761,0250 - PHARMACY -  GENERAL CLASSIFICATION,CETIRIZINE HCL TAB 10 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00116200116,RX,,00116200116,0250 - PHARMACY -  GENERAL CLASSIFICATION,CHLORHEXIDINE GLUCONATE SOLN 0.12%,1,10.71, 10.17 ,10.5, 10.17 , 10.39 , 10.17 ,Current Medicare Rates,10.39,10.28,Included in per diem,10.17,Included in ER Case rate,10.17,10.17, 10.50 ,9.639
Rx08137003601,RX,,08137003601,0250 - PHARMACY -  GENERAL CLASSIFICATION,DIMETHICONE LOTION 1.3%,1,24.19, 22.98 ,23.71, 22.98 , 23.46 , 22.98 ,Current Medicare Rates,23.46,23.22,Included in per diem,22.98,Included in ER Case rate,22.98,22.98, 23.71 ,21.771
Rx61314065605,RX,,61314065605,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT),1,59.93, 56.93 ,58.73, 56.93 , 58.13 , 56.93 ,Current Medicare Rates,58.13,57.53,Included in per diem,56.93,Included in ER Case rate,56.93,56.93, 58.73 ,53.937
Rx61314065625,RX,,61314065625,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT),1,44.95, 42.70 ,44.05, 42.70 , 43.60 , 42.70 ,Current Medicare Rates,43.6,43.15,Included in per diem,42.7,Included in ER Case rate,42.7,42.7, 44.05 ,40.455
Rx69315030802,RX,,69315030802,0250 - PHARMACY -  GENERAL CLASSIFICATION,CIPROFLOXACIN HCL OPHTH SOLN 0.3% (BASE EQUIVALENT),1,30.77, 29.23 ,30.15, 29.23 , 29.85 , 29.23 ,Current Medicare Rates,29.85,29.54,Included in per diem,29.23,Included in ER Case rate,29.23,29.23, 30.15 ,27.693
Rx63739026310,RX,,63739026310,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONAZEPAM TAB 0.5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx16729013600,RX,,16729013600,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONAZEPAM TAB 0.5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60687054401,RX,,60687054401,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONAZEPAM TAB 0.5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx60687054411,RX,,60687054411,0250 - PHARMACY -  GENERAL CLASSIFICATION,CLONAZEPAM TAB 0.5 MG,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50484001030,RX,,50484001030,0250 - PHARMACY -  GENERAL CLASSIFICATION,COLLAGENASE OINT 250 UNIT/GM,1,754.39, 716.67 ,739.3, 716.67 , 731.76 , 716.67 ,Current Medicare Rates,731.76,724.21,Included in per diem,716.67,Included in ER Case rate,716.67,716.67, 739.30 ,678.951
Rx00186091706,RX,,00186091706,0250 - PHARMACY -  GENERAL CLASSIFICATION,BUDESONIDE INHAL AERO POWD 90 MCG/ACT (BREATH ACTIVATED),1,503.33, 478.16 ,493.26, 478.16 , 488.23 , 478.16 ,Current Medicare Rates,488.23,483.2,Included in per diem,478.16,Included in ER Case rate,478.16,478.16, 493.26 ,452.997
Rx68084030011,RX,,68084030011,0250 - PHARMACY -  GENERAL CLASSIFICATION,DANTROLENE SODIUM CAP 25 MG,1,25.83, 24.54 ,25.31, 24.54 , 25.06 , 24.54 ,Current Medicare Rates,25.06,24.8,Included in per diem,24.54,Included in ER Case rate,24.54,24.54, 25.31 ,23.247
Rx48582051201,RX,,48582051201,0250 - PHARMACY -  GENERAL CLASSIFICATION,ARTIFICIAL SALIVA - GEL,1,30.36, 28.84 ,29.75, 28.84 , 29.45 , 28.84 ,Current Medicare Rates,29.45,29.15,Included in per diem,28.84,Included in ER Case rate,28.84,28.84, 29.75 ,27.324
Rx00002512301,RX,,00002512301,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRASUGREL HCL TAB 10 MG (BASE EQUIV),1,27.38, 26.01 ,26.83, 26.01 , 26.56 , 26.01 ,Current Medicare Rates,26.56,26.28,Included in per diem,26.01,Included in ER Case rate,26.01,26.01, 26.83 ,24.642
Rx60505464303,RX,,60505464303,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRASUGREL HCL TAB 10 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx65862083030,RX,,65862083030,0250 - PHARMACY -  GENERAL CLASSIFICATION,PRASUGREL HCL TAB 10 MG (BASE EQUIV),1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx67877010501,RX,,67877010501,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZONATATE CAP 100 MG,1,7.02, 6.67 ,6.88, 6.67 , 6.81 , 6.67 ,Current Medicare Rates,6.81,6.74,Included in per diem,6.67,Included in ER Case rate,6.67,6.67, 6.88 ,6.318
Rx60687011511,RX,,60687011511,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZONATATE CAP 100 MG,1,8.12, 7.71 ,7.96, 7.71 , 7.88 , 7.71 ,Current Medicare Rates,7.88,7.8,Included in per diem,7.71,Included in ER Case rate,7.71,7.71, 7.96 ,7.308
Rx63739002910,RX,,63739002910,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZONATATE CAP 100 MG,1,8.07, 7.67 ,7.91, 7.67 , 7.83 , 7.67 ,Current Medicare Rates,7.83,7.75,Included in per diem,7.67,Included in ER Case rate,7.67,7.67, 7.91 ,7.263
Rx60687034601,RX,,60687034601,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZONATATE CAP 100 MG,1,8.1, 7.70 ,7.94, 7.70 , 7.86 , 7.70 ,Current Medicare Rates,7.86,7.78,Included in per diem,7.7,Included in ER Case rate,7.7,7.7, 7.94 ,7.29
Rx60687034611,RX,,60687034611,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZONATATE CAP 100 MG,1,8.11, 7.70 ,7.95, 7.70 , 7.87 , 7.70 ,Current Medicare Rates,7.87,7.79,Included in per diem,7.7,Included in ER Case rate,7.7,7.7, 7.95 ,7.299
Rx00904656461,RX,,00904656461,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZONATATE CAP 100 MG,1,7.36, 6.99 ,7.21, 6.99 , 7.14 , 6.99 ,Current Medicare Rates,7.14,7.07,Included in per diem,6.99,Included in ER Case rate,6.99,6.99, 7.21 ,6.624
Rx00904552361,RX,,00904552361,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXAZOSIN MESYLATE TAB 2 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079095801,RX,,51079095801,0250 - PHARMACY -  GENERAL CLASSIFICATION,DOXAZOSIN MESYLATE TAB 2 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084017411,RX,,68084017411,0250 - PHARMACY -  GENERAL CLASSIFICATION,DRONABINOL CAP 2.5 MG,1,17.73, 16.84 ,17.38, 16.84 , 17.20 , 16.84 ,Current Medicare Rates,17.2,17.02,Included in per diem,16.84,Included in ER Case rate,16.84,16.84, 17.38 ,15.957
Rx17478076106,RX,,17478076106,0250 - PHARMACY -  GENERAL CLASSIFICATION,DRONABINOL CAP 2.5 MG,1,14.65, 13.92 ,14.36, 13.92 , 14.21 , 13.92 ,Current Medicare Rates,14.21,14.06,Included in per diem,13.92,Included in ER Case rate,13.92,13.92, 14.36 ,13.185
Rx00904714461,RX,,00904714461,0250 - PHARMACY -  GENERAL CLASSIFICATION,DRONABINOL CAP 2.5 MG,1,15.79, 15.00 ,15.47, 15.00 , 15.32 , 15.00 ,Current Medicare Rates,15.32,15.16,Included in per diem,15,Included in ER Case rate,15,15, 15.47 ,14.211
Rx00904550261,RX,,00904550261,0250 - PHARMACY -  GENERAL CLASSIFICATION,ENALAPRIL MALEATE TAB 5 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079095101,RX,,51079095101,0250 - PHARMACY -  GENERAL CLASSIFICATION,ENALAPRIL MALEATE TAB 5 MG,1,5.98, 5.68 ,5.86, 5.68 , 5.80 , 5.68 ,Current Medicare Rates,5.8,5.74,Included in per diem,5.68,Included in ER Case rate,5.68,5.68, 5.86 ,5.382
Rx00378145401,RX,,00378145401,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESTRADIOL TAB 1 MG,1,6.57, 6.24 ,6.44, 6.24 , 6.37 , 6.24 ,Current Medicare Rates,6.37,6.31,Included in per diem,6.24,Included in ER Case rate,6.24,6.24, 6.44 ,5.913
Rx00555088602,RX,,00555088602,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESTRADIOL TAB 1 MG,1,6.2, 5.89 ,6.08, 5.89 , 6.01 , 5.89 ,Current Medicare Rates,6.01,5.95,Included in per diem,5.89,Included in ER Case rate,5.89,5.89, 6.08 ,5.58
Rx51862033301,RX,,51862033301,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESTRADIOL TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx42806008801,RX,,42806008801,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESTRADIOL TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx76385010401,RX,,76385010401,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZTROPINE MESYLATE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687036801,RX,,60687036801,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZTROPINE MESYLATE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx60687036811,RX,,60687036811,0250 - PHARMACY -  GENERAL CLASSIFICATION,BENZTROPINE MESYLATE TAB 1 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00338066904,RX,,00338066904,0250 - PHARMACY -  GENERAL CLASSIFICATION,KCL 10 MEQ/L (0.075%) IN DEXTROSE 5% & NACL 0.45% INJ,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00264761200,RX,,00264761200,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00264761220,RX,,00264761220,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338008503,RX,,00338008503,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338008504,RX,,00338008504,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409793009,RX,,00409793009,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 10%,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00264752010,RX,,00264752010,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 10%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338002302,RX,,00338002302,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 10%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338002303,RX,,00338002303,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 10%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338002304,RX,,00338002304,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 10%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409711807,RX,,00409711807,0250 - PHARMACY -  GENERAL CLASSIFICATION,WATER FOR IV INJECTION,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409799009,RX,,00409799009,0250 - PHARMACY -  GENERAL CLASSIFICATION,WATER FOR IV INJECTION,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00338001304,RX,,00338001304,0250 - PHARMACY -  GENERAL CLASSIFICATION,WATER FOR IV INJECTION,1,97.85, 92.96 ,95.89, 92.96 , 94.91 , 92.96 ,Current Medicare Rates,94.91,93.94,Included in per diem,92.96,Included in ER Case rate,92.96,92.96, 95.89 ,88.065
Rx10019067010,RX,,10019067010,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML,1,663.64, 630.46 ,650.37, 630.46 , 643.73 , 630.46 ,Current Medicare Rates,643.73,637.09,Included in per diem,630.46,Included in ER Case rate,630.46,630.46, 650.37 ,597.276
Rx67457065725,RX,,67457065725,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML,1,618.45, 587.53 ,606.08, 587.53 , 599.90 , 587.53 ,Current Medicare Rates,599.9,593.71,Included in per diem,587.53,Included in ER Case rate,587.53,587.53, 606.08 ,556.605
Rx10019005561,RX,,10019005561,0250 - PHARMACY -  GENERAL CLASSIFICATION,ESMOLOL HCL-SODIUM CHLORIDE IV SOLN 2500 MG/250ML,1,433.5, 411.83 ,424.83, 411.83 , 420.50 , 411.83 ,Current Medicare Rates,420.5,416.16,Included in per diem,411.83,Included in ER Case rate,411.83,411.83, 424.83 ,390.15
Rx00264761210,RX,,00264761210,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% W/ SODIUM CHLORIDE 0.45%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338008903,RX,,00338008903,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338008904,RX,,00338008904,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% W/ SODIUM CHLORIDE 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409792202,RX,,00409792202,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,100.74, 95.70 ,98.73, 95.70 , 97.72 , 95.70 ,Current Medicare Rates,97.72,96.71,Included in per diem,95.7,Included in ER Case rate,95.7,95.7, 98.73 ,90.666
Rx00409792336,RX,,00409792336,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409792323,RX,,00409792323,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00264751010,RX,,00264751010,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338634603,RX,,00338634603,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,95.91, 91.11 ,93.99, 91.11 , 93.03 , 91.11 ,Current Medicare Rates,93.03,92.07,Included in per diem,91.11,Included in ER Case rate,91.11,91.11, 93.99 ,86.319
Rx00338001703,RX,,00338001703,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338001704,RX,,00338001704,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338001741,RX,,00338001741,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338001748,RX,,00338001748,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE INJ 5%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409798302,RX,,00409798302,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,100.74, 95.70 ,98.73, 95.70 , 97.72 , 95.70 ,Current Medicare Rates,97.72,96.71,Included in per diem,95.7,Included in ER Case rate,95.7,95.7, 98.73 ,90.666
Rx00264780010,RX,,00264780010,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00264780020,RX,,00264780020,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338004902,RX,,00338004902,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338004903,RX,,00338004903,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338004904,RX,,00338004904,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338004910,RX,,00338004910,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338012504,RX,,00338012504,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% IN LACTATED RINGERS,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338004910,RX,,00338004910,0250 - PHARMACY -  GENERAL CLASSIFICATION,SODIUM CHLORIDE IV SOLN 0.9%,1,54.07, 51.37 ,52.99, 51.37 , 52.45 , 51.37 ,Current Medicare Rates,52.45,51.91,Included in per diem,51.37,Included in ER Case rate,51.37,51.37, 52.99 ,48.663
Rx00264775010,RX,,00264775010,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTATED RINGER'S SOLUTION,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338011702,RX,,00338011702,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTATED RINGER'S SOLUTION,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338011704,RX,,00338011704,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTATED RINGER'S SOLUTION,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409795309,RX,,00409795309,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTATED RINGER'S SOLUTION,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00264775020,RX,,00264775020,0250 - PHARMACY -  GENERAL CLASSIFICATION,LACTATED RINGER'S SOLUTION,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00264775100,RX,,00264775100,0250 - PHARMACY -  GENERAL CLASSIFICATION,DEXTROSE 5% IN LACTATED RINGERS,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
26010006,EAP,CPT® 36592,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Collect Blood From Picc,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
26010005,EAP,CPT® 36591,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Draw Blood Off Venous Device,1,168, 159.60 ,164.64, 159.60 , 162.96 , 159.60 ,Current Medicare Rates,162.96,161.28,Included in per diem,159.6,Included in ER Case rate,159.6,159.6, 164.64 ,151.2
26010008,EAP,CPT® 96361,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Hydrate Iv Infusion Add-on^,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
26010007,EAP,CPT® 96360,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Hydration Iv Infusion Init^,1,330, 313.50 ,323.4, 313.50 , 320.10 , 313.50 ,Current Medicare Rates,320.1,316.8,Included in per diem,313.5,Included in ER Case rate,313.5,313.5, 323.40 ,297
26010012,EAP,CPT® 96368,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Ther/diag Concurrent Inf^,1,257, 244.15 ,251.86, 244.15 , 249.29 , 244.15 ,Current Medicare Rates,249.29,246.72,Included in per diem,244.15,Included in ER Case rate,244.15,244.15, 251.86 ,231.3
94010205,EAP,CPT® 96372,,0260 - IV THERAPY - GENERAL CLASSIFICATION,HC THER/PROPH/DIAG INJ SC/IM^,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,Included in per diem,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
26010010,EAP,CPT® 96366,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Ther/proph/diag Iv Inf Addon^,1,124, 117.80 ,121.52, 117.80 , 120.28 , 117.80 ,Current Medicare Rates,120.28,119.04,Included in per diem,117.8,Included in ER Case rate,117.8,117.8, 121.52 ,111.6
26010009,EAP,CPT® 96365,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Ther/proph/diag Iv Inf Init^,1,333, 316.35 ,326.34, 316.35 , 323.01 , 316.35 ,Current Medicare Rates,323.01,319.68,Included in per diem,316.35,Included in ER Case rate,316.35,316.35, 326.34 ,299.7
26010011,EAP,CPT® 96367,,0260 - IV THERAPY - GENERAL CLASSIFICATION,Hc Tx/proph/dg Addl Seq Iv Inf^,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
3254151WWM,EAP,3254151WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC NEEDLE EZ-IO 25MM (#9001-VC-001),1,548, 520.60 ,537.04, 520.60 , 531.56 , 520.60 ,Current Medicare Rates,531.56,526.08,Included in per diem,520.6,Included in ER Case rate,520.6,520.6, 537.04 ,493.2
3253501WWM,EAP,3253501WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC SLING PELVIC LG #556653,1,478, 454.10 ,468.44, 454.10 , 463.66 , 454.10 ,Current Medicare Rates,463.66,458.88,Included in per diem,454.1,Included in ER Case rate,454.1,454.1, 468.44 ,430.2
3253500WWM,EAP,3253500WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC SLING PELVIC MED #556652,1,342, 324.90 ,335.16, 324.90 , 331.74 , 324.90 ,Current Medicare Rates,331.74,328.32,Included in per diem,324.9,Included in ER Case rate,324.9,324.9, 335.16 ,307.8
3253095WWM,EAP,3253095WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC SPLINT SAM 4 1/4 X 36 (#37155),1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
3253796WWM,EAP,Custom 3253796WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc  Or Cannula Passport 8x20,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,Included in per diem,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
3253830WWM,EAP,Custom 3253830WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc  Or Harmonic Long#fcs17,1,1111," 1,055.45 ",1088.78," 1,055.45 "," 1,077.67 "," 1,055.45 ",Current Medicare Rates,1077.67,1066.56,Included in per diem,1055.45,Included in ER Case rate,1055.45,1055.45," 1,088.78 ",999.9
3253956WWM,EAP,Custom 3253956WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc  Or Peg Full 2.5x20# Fp20,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
3253709WWM,EAP,Custom 3253709WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Abd Binder Lg #79-89047,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3253708WWM,EAP,Custom 3253708WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Abd Binder Med #79-89045,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3253710WWM,EAP,Custom 3253710WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Abd Binder Xlg #79-89048,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3254185WWM,EAP,Custom 3254185WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Abd Binder Xxl #79-89210,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
3254017WWM,EAP,Custom 3254017WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Air Walk Ank Lg#79-95527,1,143, 135.85 ,140.14, 135.85 , 138.71 , 135.85 ,Current Medicare Rates,138.71,137.28,Included in per diem,135.85,Included in ER Case rate,135.85,135.85, 140.14 ,128.7
3254016WWM,EAP,Custom 3254016WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Air Walk Ank Md#79-95525,1,143, 135.85 ,140.14, 135.85 , 138.71 , 135.85 ,Current Medicare Rates,138.71,137.28,Included in per diem,135.85,Included in ER Case rate,135.85,135.85, 140.14 ,128.7
3254015WWM,EAP,Custom 3254015WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Air Walk Ank Sm#79-95523,1,143, 135.85 ,140.14, 135.85 , 138.71 , 135.85 ,Current Medicare Rates,138.71,137.28,Included in per diem,135.85,Included in ER Case rate,135.85,135.85, 140.14 ,128.7
3252586WWM,EAP,Custom 3252586WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Air Walk Cast Lg#aw0800bl,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3252587WWM,EAP,Custom 3252587WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Air Walk Cast Md# Aw0600b,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3250628WWM,EAP,Custom 3250628WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Air Walk Cast Sm #aw0400b,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3252925WWM,EAP,Custom 3252925WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Air Walk Cast Xl #aw1000b,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3253837WWM,EAP,Custom 3253837WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Allaris Et Co2 #010433,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
3253839WWM,EAP,Custom 3253839WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc An Tray Epidural #sd18td,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
4171309WWM,EAP,Custom 4171309WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Aquaphor,1,42, 39.90 ,41.16, 39.90 , 40.74 , 39.90 ,Current Medicare Rates,40.74,40.32,Included in per diem,39.9,Included in ER Case rate,39.9,39.9, 41.16 ,37.8
3252612WWM,EAP,Custom 3252612WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Bag Ambu Adlt#520611000,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
3252611WWM,EAP,Custom 3252611WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Bag Ambu Chld/inf#5302150,1,154, 146.30 ,150.92, 146.30 , 149.38 , 146.30 ,Current Medicare Rates,149.38,147.84,Included in per diem,146.3,Included in ER Case rate,146.3,146.3, 150.92 ,138.6
3254070WWM,EAP,Custom 3254070WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Bag Bvm Adult # 10-56069,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
262147L,EAP,Custom 262147L,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC BAKRI POSTPARTUM BALLOON,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
3253804WWM,EAP,Custom 3253804WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Blanket Full # 30000,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253805WWM,EAP,Custom 3253805WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Blanket Multi # 31500,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3253803WWM,EAP,Custom 3253803WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Blanket Under #63500,1,130, 123.50 ,127.4, 123.50 , 126.10 , 123.50 ,Current Medicare Rates,126.1,124.8,Included in per diem,123.5,Included in ER Case rate,123.5,123.5, 127.40 ,117
3254184WWM,EAP,Custom 3254184WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Bougie Introducer #9-0212-70,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
3253417WWM,EAP,Custom 3253417WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Calmoseptine #0799000102,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252964WWM,EAP,Custom 3252964WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cast Shoe M #140504,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
3250124WWM,EAP,Custom 3250124WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cast Shoe S #140503,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
3250128WWM,EAP,Custom 3250128WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cast Shoe Xs #140502,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3253505WWM,EAP,Custom 3253505WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Cast Tape  Lt Blu 2""",1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
3253321WWM,EAP,Custom 3253321WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Cast Tape  Lt Blu 3""",1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253504WWM,EAP,Custom 3253504WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Cast Tape  Purpl 2""",1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
3253319WWM,EAP,Custom 3253319WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Cast Tape  Purpl 3""",1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253023WWM,EAP,Custom 3253023WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath 3 Way 16fr,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
3253414WWM,EAP,Custom 3253414WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath 3 Way Irri 24fr,1,56, 53.20 ,54.88, 53.20 , 54.32 , 53.20 ,Current Medicare Rates,54.32,53.76,Included in per diem,53.2,Included in ER Case rate,53.2,53.2, 54.88 ,50.4
3250166WWM,EAP,Custom 3250166WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath 3way Irr 18f 7688185,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
3252987WWM,EAP,Custom 3252987WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath 3way Irr 22f#7688227,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252013WWM,EAP,Custom 3252013WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Coude 14fr,1,103, 97.85 ,100.94, 97.85 , 99.91 , 97.85 ,Current Medicare Rates,99.91,98.88,Included in per diem,97.85,Included in ER Case rate,97.85,97.85, 100.94 ,92.7
3250156WWM,EAP,Custom 3250156WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Coude 16fr,1,103, 97.85 ,100.94, 97.85 , 99.91 , 97.85 ,Current Medicare Rates,99.91,98.88,Included in per diem,97.85,Included in ER Case rate,97.85,97.85, 100.94 ,92.7
3250157WWM,EAP,Custom 3250157WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Coude 18fr,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
3254144WWM,EAP,Custom 3254144WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Emergency Airway #g09413,1,246, 233.70 ,241.08, 233.70 , 238.62 , 233.70 ,Current Medicare Rates,238.62,236.16,Included in per diem,233.7,Included in ER Case rate,233.7,233.7, 241.08 ,221.4
3250164WWM,EAP,Custom 3250164WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Female Kit #0035380,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3250170WWM,EAP,Custom 3250170WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Fol/tray 16fr#899616,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3252939WWM,EAP,Custom 3252939WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Fol/tray 16fr#907316,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
3252938WWM,EAP,Custom 3252938WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Fol/tray 18 #907318,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
3250132WWM,EAP,Custom 3250132WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 10/3 #0165pl10,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3250141WWM,EAP,Custom 3250141WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 10/30 #165810,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
3252552WWM,EAP,Custom 3252552WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 12fr6cc#165812,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,Included in per diem,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
3250133WWM,EAP,Custom 3250133WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 14fr/5cc165814,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,Included in per diem,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
3252551WWM,EAP,Custom 3252551WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 16fr5cc#165816,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
3250135WWM,EAP,Custom 3250135WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 18fr/5cc#33618,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
3250146WWM,EAP,Custom 3250146WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 20/30 #166820,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
3250147WWM,EAP,Custom 3250147WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 22fr/30#126622,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
3250150WWM,EAP,Custom 3250150WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley 28fr/30#266728,1,41, 38.95 ,40.18, 38.95 , 39.77 , 38.95 ,Current Medicare Rates,39.77,39.36,Included in per diem,38.95,Included in ER Case rate,38.95,38.95, 40.18 ,36.9
3253041WWM,EAP,Custom 3253041WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Foley Meter 16fr,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
3250474WWM,EAP,Custom 3250474WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Kit Infant #0035630,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
3250171WWM,EAP,Custom 3250171WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Strght 16fr #772416,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3253852WWM,EAP,Custom 3253852WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cath Temp Prob 16fr#21096,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
3252512WWM,EAP,Custom 3252512WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Central Line 3 L#ak14703a,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
3250179WWM,EAP,Custom 3250179WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Clavical Brace Lg #152677,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
3250178WWM,EAP,Custom 3250178WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Clavical Brace Md #151489,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
3252683WWM,EAP,Custom 3252683WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Clavical Brace Xs #152678,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
3250173WWM,EAP,Custom 3250173WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Collar Cervical M #4051,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3250172WWM,EAP,Custom 3250172WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Collar Cervical Sm #4050,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
3253981WWM,EAP,Custom 3253981WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Collar Vista Adt#79-83370,1,193, 183.35 ,189.14, 183.35 , 187.21 , 183.35 ,Current Medicare Rates,187.21,185.28,Included in per diem,183.35,Included in ER Case rate,183.35,183.35, 189.14 ,173.7
3253983WWM,EAP,Custom 3253983WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Collar Vista Ped 2#79-832,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253984WWM,EAP,Custom 3253984WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Collar Vista Ped 3#79-832,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3261003WWM,EAP,A4421,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC CONVATEC ADAPTER RING 2.25,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
3261003WWM,EAP,A4421,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC CONVATEC ADAPTER RING 2.25,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
3261002WWM,EAP,A4425,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC CONVATEC NATURA POUCH 1.25-1.75,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3261002WWM,EAP,A4425,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC CONVATEC NATURA POUCH 1.25-1.75,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3261001WWM,EAP,A4407,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC CONVATEC SURFIT NATURA WAFER,1,140, 133.00 ,137.2, 133.00 , 135.80 , 133.00 ,Current Medicare Rates,135.8,134.4,Included in per diem,133,Included in ER Case rate,133,133, 137.20 ,126
3261001WWM,EAP,A4407,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC CONVATEC SURFIT NATURA WAFER,1,140, 133.00 ,137.2, 133.00 , 135.80 , 133.00 ,Current Medicare Rates,135.8,134.4,Included in per diem,133,Included in ER Case rate,133,133, 137.20 ,126
4090201WWM,EAP,HCPCS E0935,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Cpm Per Day,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3254063WWM,EAP,Custom 3254063WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Acticoat 4x4 #66800406,1,42, 39.90 ,41.16, 39.90 , 40.74 , 39.90 ,Current Medicare Rates,40.74,40.32,Included in per diem,39.9,Included in ER Case rate,39.9,39.9, 41.16 ,37.8
3252951WWM,EAP,Custom 3252951WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Alldress 4x4#265324,1,11, 10.45 ,10.78, 10.45 , 10.67 , 10.45 ,Current Medicare Rates,10.67,10.56,Included in per diem,10.45,Included in ER Case rate,10.45,10.45, 10.78 ,9.9
3252950WWM,EAP,Custom 3252950WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Alldress 6x6#265346,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3254031WWM,EAP,Custom 3254031WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Allevyn 5x5#66000805,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
3254033WWM,EAP,Custom 3254033WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Allevyn 9x9#66800506,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3253648WWM,EAP,Custom 3253648WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Barrier Cream#m3355,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3253419WWM,EAP,Custom 3253419WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Biopatch #et3152,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
3254025WWM,EAP,Custom 3254025WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Compression #m2094,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3254055WWM,EAP,Custom 3254055WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Compression Lite # M2794,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3253810WWM,EAP,Custom 3253810WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Hydro Ovl 4x5#m90001,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3253650WWM,EAP,Custom 3253650WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Hydro Sacral#m90007,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
3253809WWM,EAP,Custom 3253809WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Hydro Sqr 4x4#m90002,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3253811WWM,EAP,Custom 3253811WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Hydro Thin 4x4#m9002,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3253812WWM,EAP,Custom 3253812WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Hydro Thin 4x5#m9002,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3252541WWM,EAP,Custom 3252541WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Kaltostat Rope#8117,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
3253865WWM,EAP,Custom 3253865WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Medihoney # 31515,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
3253814WWM,EAP,Custom 3253814WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Mepitel Soft 2x3#mhc,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3253813WWM,EAP,Custom 3253813WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Mepitel Soft 3x4#mhc,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3254064WWM,EAP,Custom 3254064WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Nonadhes Foam # M90601,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3254050WWM,EAP,Custom 3254050WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Normlgel # 52567,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,Included in per diem,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
3254213WWM,EAP,3254213WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC DRSG OPTIFOAM 6X6 #MSC1066EPZ,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
3254109WWM,EAP,Custom 3254109WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Optifoam Adh 4x4 #msc1244ep,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
3254108WWM,EAP,Custom 3254108WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Optifoam Adh 6x6 #msc1244ep,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
3252829WWM,EAP,Custom 3252829WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Polymem 4x4 #5044,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3254104WWM,EAP,Custom 3254104WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Quik Clot Combat Gauze #zm198b,1,156, 148.20 ,152.88, 148.20 , 151.32 , 148.20 ,Current Medicare Rates,151.32,149.76,Included in per diem,148.2,Included in ER Case rate,148.2,148.2, 152.88 ,140.4
3254060WWM,EAP,Custom 3254060WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Tegaderm Silver 4x5 # M90501,1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
3254061WWM,EAP,Custom 3254061WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Tegagen Alginate 4x4 # M90112,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,Included in per diem,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
3254062WWM,EAP,Custom 3254062WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Drsg Tegagen Alginate Rope # M90120,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3250585WWM,EAP,Custom 3250585WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Elastoplast 4""",1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253105WWM,EAP,Custom 3253105WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Electrode Quik Combo 2pk,1,131, 124.45 ,128.38, 124.45 , 127.07 , 124.45 ,Current Medicare Rates,127.07,125.76,Included in per diem,124.45,Included in ER Case rate,124.45,124.45, 128.38 ,117.9
3254191WWM,EAP,Custom 3254191WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Electrode Zoll Adt 8900 0214 01,1,270, 256.50 ,264.6, 256.50 , 261.90 , 256.50 ,Current Medicare Rates,261.9,259.2,Included in per diem,256.5,Included in ER Case rate,256.5,256.5, 264.60 ,243
3254190WWM,EAP,Custom 3254190WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Electrode Zoll Ped 8900 000220 01,1,257, 244.15 ,251.86, 244.15 , 249.29 , 244.15 ,Current Medicare Rates,249.29,246.72,Included in per diem,244.15,Included in ER Case rate,244.15,244.15, 251.86 ,231.3
4170368WWM,EAP,Custom 4170368WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Eucerin,1,42, 39.90 ,41.16, 39.90 , 40.74 , 39.90 ,Current Medicare Rates,40.74,40.32,Included in per diem,39.9,Included in ER Case rate,39.9,39.9, 41.16 ,37.8
3254143WWM,EAP,3254143WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC EZ-IO STABILIZER (#9066-VC-005),1,119, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3254212WWM,EAP,3254212WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC FEED BAG #70552H,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
3253491WWM,EAP,Custom 3253491WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Feed Bag #no199547,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
3253061WWM,EAP,Custom 3253061WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Fiberwire #2    #ar-7200,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
3261000WWM,EAP,Custom 3261000WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Fmp 30ml,1,"1,435.00"," 1,363.25 ",1406.3," 1,363.25 "," 1,391.95 "," 1,363.25 ",Current Medicare Rates,1391.95,1377.6,Included in per diem,1363.25,Included in ER Case rate,1363.25,1363.25," 1,406.30 ",1291.5
3254176WWM,EAP,Custom 3254176WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Gown Bair Hugger #84003,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
3253806WWM,EAP,Custom 3253806WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Gown Kit Flex # 84003,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,Included in per diem,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
3254059WWM,EAP,Custom 3254059WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Heelbo Lg #802-12061,1,185, 175.75 ,181.3, 175.75 , 179.45 , 175.75 ,Current Medicare Rates,179.45,177.6,Included in per diem,175.75,Included in ER Case rate,175.75,175.75, 181.30 ,166.5
3254058WWM,EAP,Custom 3254058WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Heelbo Md # 802-12060,1,185, 175.75 ,181.3, 175.75 , 179.45 , 175.75 ,Current Medicare Rates,179.45,177.6,Included in per diem,175.75,Included in ER Case rate,175.75,175.75, 181.30 ,166.5
3254057WWM,EAP,Custom 3254057WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Heelbo Sm # 12059,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
3252908WWM,EAP,Custom 3252908WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Immobl Shoulder L #331005,1,97, 92.15 ,95.06, 92.15 , 94.09 , 92.15 ,Current Medicare Rates,94.09,93.12,Included in per diem,92.15,Included in ER Case rate,92.15,92.15, 95.06 ,87.3
3252703WWM,EAP,Custom 3252703WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Immobl Shoulder M #331004,1,97, 92.15 ,95.06, 92.15 , 94.09 , 92.15 ,Current Medicare Rates,94.09,93.12,Included in per diem,92.15,Included in ER Case rate,92.15,92.15, 95.06 ,87.3
3252705WWM,EAP,Custom 3252705WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Immobl Shoulder Xl#331006,1,97, 92.15 ,95.06, 92.15 , 94.09 , 92.15 ,Current Medicare Rates,94.09,93.12,Included in per diem,92.15,Included in ER Case rate,92.15,92.15, 95.06 ,87.3
3250253WWM,EAP,Custom 3250253WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Irrig Cysto/blad #2c4040,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
3253420WWM,EAP,Custom 3253420WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Iv Cl Secure #cv0220,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
3253162WWM,EAP,Custom 3253162WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Iv Picc 4 #3174108d,1,512, 486.40 ,501.76, 486.40 , 496.64 , 486.40 ,Current Medicare Rates,496.64,491.52,Included in per diem,486.4,Included in ER Case rate,486.4,486.4, 501.76 ,460.8
3253667WWM,EAP,Custom 3253667WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Iv Picc 5 Fr #3275108d,1,467, 443.65 ,457.66, 443.65 , 452.99 , 443.65 ,Current Medicare Rates,452.99,448.32,Included in per diem,443.65,Included in ER Case rate,443.65,443.65, 457.66 ,420.3
3253421WWM,EAP,Custom 3253421WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Iv Picc Secure #vppdfp,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3253867WWM,EAP,Custom 3253867WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Lopez Valve #b0056000,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,Included in per diem,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
3254096WWM,EAP,Custom 3254096WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Malyugin Ring,1,396, 376.20 ,388.08, 376.20 , 384.12 , 376.20 ,Current Medicare Rates,384.12,380.16,Included in per diem,376.2,Included in ER Case rate,376.2,376.2, 388.08 ,356.4
3254214WWM,EAP,3254214WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC MEDIHONEY.5OZ (#788895),1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
3261004WWM,EAP,A6212,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC MEDLINE OPTIFORM GENTLE 4X4 FOAM DRESSING,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
3261004WWM,EAP,A6212,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC MEDLINE OPTIFORM GENTLE 4X4 FOAM DRESSING,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
3250772WWM,EAP,Custom 3250772WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Morgan Lens,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
3253880WWM,EAP,Custom 3253880WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Brst Pump Dbl#67116-06,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3250072WWM,EAP,Custom 3250072WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Brst Pump Manual#67100,1,143, 135.85 ,140.14, 135.85 , 138.71 , 135.85 ,Current Medicare Rates,138.71,137.28,Included in per diem,135.85,Included in ER Case rate,135.85,135.85, 140.14 ,128.7
3252916WWM,EAP,Custom 3252916WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Cath Umbil 3.5#160218,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
3254103WWM,EAP,Custom 3254103WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Cerv Ripen Ballon #g19891,1,149, 141.55 ,146.02, 141.55 , 144.53 , 141.55 ,Current Medicare Rates,144.53,143.04,Included in per diem,141.55,Included in ER Case rate,141.55,141.55, 146.02 ,134.1
3252900WWM,EAP,Custom 3252900WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Koala Intr/cathipc5000,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
3254216WWM,EAP,3254216WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,HC OB KOALA INTRA/IUPC/CATH,1,282, 267.90 ,276.36, 267.90 , 273.54 , 267.90 ,Current Medicare Rates,273.54,270.72,Included in per diem,267.9,Included in ER Case rate,267.9,267.9, 276.36 ,253.8
3253459WWM,EAP,Custom 3253459WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Mityvac #10058,1,189, 179.55 ,185.22, 179.55 , 183.33 , 179.55 ,Current Medicare Rates,183.33,181.44,Included in per diem,179.55,Included in ER Case rate,179.55,179.55, 185.22 ,170.1
3253001WWM,EAP,Custom 3253001WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Newborn Screening,1,207, 196.65 ,202.86, 196.65 , 200.79 , 196.65 ,Current Medicare Rates,200.79,198.72,Included in per diem,196.65,Included in ER Case rate,196.65,196.65, 202.86 ,186.3
3252893WWM,EAP,Custom 3252893WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Para/puden Blk #4540a,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
3254119WWM,EAP,Custom 3254119WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Postpartum Balloon #g24237,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3254198WWM,EAP,Custom 3254198WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Scalp Elect. #crm7000aa0h,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
3252958WWM,EAP,Custom 3252958WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Scalp Electrod#7000aao,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3252937WWM,EAP,Custom 3252937WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Sensor Spo2 #1002,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
3253964WWM,EAP,Custom 3253964WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Tp Resus #10-50810,1,121, 114.95 ,118.58, 114.95 , 117.37 , 114.95 ,Current Medicare Rates,117.37,116.16,Included in per diem,114.95,Included in ER Case rate,114.95,114.95, 118.58 ,108.9
3250652WWM,EAP,Custom 3250652WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ob Tube Asp/meconi#n0101,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
3252989WWM,EAP,Custom 3252989WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or 3mm Ldb Cath #ldc315,1,478, 454.10 ,468.44, 454.10 , 463.66 , 454.10 ,Current Medicare Rates,463.66,458.88,Included in per diem,454.1,Included in ER Case rate,454.1,454.1, 468.44 ,430.2
3253940WWM,EAP,Custom 3253940WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ablator 90#ar-9705a-90,1,473, 449.35 ,463.54, 449.35 , 458.81 , 449.35 ,Current Medicare Rates,458.81,454.08,Included in per diem,449.35,Included in ER Case rate,449.35,449.35, 463.54 ,425.7
3253917WWM,EAP,Custom 3253917WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ablator 90#ar-9803a-90,1,447, 424.65 ,438.06, 424.65 , 433.59 , 424.65 ,Current Medicare Rates,433.59,429.12,Included in per diem,424.65,Included in ER Case rate,424.65,424.65, 438.06 ,402.3
3253912WWM,EAP,Custom 3253912WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Aggres Plus 4.0#375-54,1,205, 194.75 ,200.9, 194.75 , 198.85 , 194.75 ,Current Medicare Rates,198.85,196.8,Included in per diem,194.75,Included in ER Case rate,194.75,194.75, 200.90 ,184.5
3253393WWM,EAP,Custom 3253393WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Aggres Plus 4.0#375544,1,225, 213.75 ,220.5, 213.75 , 218.25 , 213.75 ,Current Medicare Rates,218.25,216,Included in per diem,213.75,Included in ER Case rate,213.75,213.75, 220.50 ,202.5
3253385WWM,EAP,Custom 3253385WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Aggres Plus 5.5#375564,1,205, 194.75 ,200.9, 194.75 , 198.85 , 194.75 ,Current Medicare Rates,198.85,196.8,Included in per diem,194.75,Included in ER Case rate,194.75,194.75, 200.90 ,184.5
3253390WWM,EAP,Custom 3253390WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Anchor Xcel 3.0,1,562, 533.90 ,550.76, 533.90 , 545.14 , 533.90 ,Current Medicare Rates,545.14,539.52,Included in per diem,533.9,Included in ER Case rate,533.9,533.9, 550.76 ,505.8
3254107WWM,EAP,Custom 3254107WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Apollo Rf 90 #ar-9811,1,462, 438.90 ,452.76, 438.90 , 448.14 , 438.90 ,Current Medicare Rates,448.14,443.52,Included in per diem,438.9,Included in ER Case rate,438.9,438.9, 452.76 ,415.8
3253531WWM,EAP,Custom 3253531WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Arthro Resector,1,205, 194.75 ,200.9, 194.75 , 198.85 , 194.75 ,Current Medicare Rates,198.85,196.8,Included in per diem,194.75,Included in ER Case rate,194.75,194.75, 200.90 ,184.5
3253574WWM,EAP,Custom 3253574WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Arthro Surfas 90s,1,444, 421.80 ,435.12, 421.80 , 430.68 , 421.80 ,Current Medicare Rates,430.68,426.24,Included in per diem,421.8,Included in ER Case rate,421.8,421.8, 435.12 ,399.6
3253575WWM,EAP,Custom 3253575WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Arthro Surfas 90s Max,1,422, 400.90 ,413.56, 400.90 , 409.34 , 400.90 ,Current Medicare Rates,409.34,405.12,Included in per diem,400.9,Included in ER Case rate,400.9,400.9, 413.56 ,379.8
3253670WWM,EAP,Custom 3253670WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Arthro Surfas Direct,1,401, 380.95 ,392.98, 380.95 , 388.97 , 380.95 ,Current Medicare Rates,388.97,384.96,Included in per diem,380.95,Included in ER Case rate,380.95,380.95, 392.98 ,360.9
3253384WWM,EAP,Custom 3253384WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Arthro Surfas Hook,1,424, 402.80 ,415.52, 402.80 , 411.28 , 402.80 ,Current Medicare Rates,411.28,407.04,Included in per diem,402.8,Included in ER Case rate,402.8,402.8, 415.52 ,381.6
3253337WWM,EAP,Custom 3253337WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Arthro Tube#0350-202-0,1,348, 330.60 ,341.04, 330.60 , 337.56 , 330.60 ,Current Medicare Rates,337.56,334.08,Included in per diem,330.6,Included in ER Case rate,330.6,330.6, 341.04 ,313.2
3253578WWM,EAP,Custom 3253578WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Arthro Unhooded Bur,1,236, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
3253338WWM,EAP,Custom 3253338WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Baker Tube 16 Fr,1,343, 325.85 ,336.14, 325.85 , 332.71 , 325.85 ,Current Medicare Rates,332.71,329.28,Included in per diem,325.85,Included in ER Case rate,325.85,325.85, 336.14 ,308.7
3253056WWM,EAP,Custom 3253056WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bio Post@washer,1,575, 546.25 ,563.5, 546.25 , 557.75 , 546.25 ,Current Medicare Rates,557.75,552,Included in per diem,546.25,Included in ER Case rate,546.25,546.25, 563.50 ,517.5
3253062WWM,EAP,Custom 3253062WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biocorkscrew 5.0,1,612, 581.40 ,599.76, 581.40 , 593.64 , 581.40 ,Current Medicare Rates,593.64,587.52,Included in per diem,581.4,Included in ER Case rate,581.4,581.4, 599.76 ,550.8
3253568WWM,EAP,Custom 3253568WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biomet Abs Screw,1,578, 549.10 ,566.44, 549.10 , 560.66 , 549.10 ,Current Medicare Rates,560.66,554.88,Included in per diem,549.1,Included in ER Case rate,549.1,549.1, 566.44 ,520.2
3253569WWM,EAP,Custom 3253569WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biomet Drill Bit 2.2,1,412, 391.40 ,403.76, 391.40 , 399.64 , 391.40 ,Current Medicare Rates,399.64,395.52,Included in per diem,391.4,Included in ER Case rate,391.4,391.4, 403.76 ,370.8
3253577WWM,EAP,Custom 3253577WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biopushlock 3.5#ar1926,1,867, 823.65 ,849.66, 823.65 , 840.99 , 823.65 ,Current Medicare Rates,840.99,832.32,Included in per diem,823.65,Included in ER Case rate,823.65,823.65, 849.66 ,780.3
3253562WWM,EAP,Custom 3253562WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biopushlock 4.5,1,881, 836.95 ,863.38, 836.95 , 854.57 , 836.95 ,Current Medicare Rates,854.57,845.76,Included in per diem,836.95,Included in ER Case rate,836.95,836.95, 863.38 ,792.9
3253618WWM,EAP,Custom 3253618WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biosuturetak,1,944, 896.80 ,925.12, 896.80 , 915.68 , 896.80 ,Current Medicare Rates,915.68,906.24,Included in per diem,896.8,Included in ER Case rate,896.8,896.8, 925.12 ,849.6
3253604WWM,EAP,Custom 3253604WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biosuturetak 3-0,1,830, 788.50 ,813.4, 788.50 , 805.10 , 788.50 ,Current Medicare Rates,805.1,796.8,Included in per diem,788.5,Included in ER Case rate,788.5,788.5, 813.40 ,747
3253680WWM,EAP,Custom 3253680WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biosuturetak Fw# Ar193,1,626, 594.70 ,613.48, 594.70 , 607.22 , 594.70 ,Current Medicare Rates,607.22,600.96,Included in per diem,594.7,Included in ER Case rate,594.7,594.7, 613.48 ,563.4
3253654WWM,EAP,Custom 3253654WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bioswivel Lock 5.5,1,907, 861.65 ,888.86, 861.65 , 879.79 , 861.65 ,Current Medicare Rates,879.79,870.72,Included in per diem,861.65,Included in ER Case rate,861.65,861.65, 888.86 ,816.3
3253868WWM,EAP,Custom 3253868WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bioswivel Lock 6.25#ar,1,972, 923.40 ,952.56, 923.40 , 942.84 , 923.40 ,Current Medicare Rates,942.84,933.12,Included in per diem,923.4,Included in ER Case rate,923.4,923.4, 952.56 ,874.8
3253645WWM,EAP,Custom 3253645WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bioteno Screw 5.5#ar15,1,944, 896.80 ,925.12, 896.80 , 915.68 , 896.80 ,Current Medicare Rates,915.68,906.24,Included in per diem,896.8,Included in ER Case rate,896.8,896.8, 925.12 ,849.6
3253602WWM,EAP,Custom 3253602WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Biotenodesis Kit,1,513, 487.35 ,502.74, 487.35 , 497.61 , 487.35 ,Current Medicare Rates,497.61,492.48,Included in per diem,487.35,Included in ER Case rate,487.35,487.35, 502.74 ,461.7
3254203WWM,EAP,Custom 3254203WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Ace 700 #me7251e,1,463, 439.85 ,453.74, 439.85 , 449.11 , 439.85 ,Current Medicare Rates,449.11,444.48,Included in per diem,439.85,Included in ER Case rate,439.85,439.85, 453.74 ,416.7
3252601WWM,EAP,Custom 3252601WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Agee Ctr#810106,1,511, 485.45 ,500.78, 485.45 , 495.67 , 485.45 ,Current Medicare Rates,495.67,490.56,Included in per diem,485.45,Included in ER Case rate,485.45,485.45, 500.78 ,459.9
3253608WWM,EAP,Custom 3253608WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Strk Av/ Md,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
3253793WWM,EAP,Custom 3253793WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Strk Lg 13mm,1,154, 146.30 ,150.92, 146.30 , 149.38 , 146.30 ,Current Medicare Rates,149.38,147.84,Included in per diem,146.3,Included in ER Case rate,146.3,146.3, 150.92 ,138.6
3253610WWM,EAP,Custom 3253610WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Strk Lg/md,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
3253783WWM,EAP,Custom 3253783WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Strk Lg/nar #229,1,154, 146.30 ,150.92, 146.30 , 149.38 , 146.30 ,Current Medicare Rates,149.38,147.84,Included in per diem,146.3,Included in ER Case rate,146.3,146.3, 150.92 ,138.6
3253607WWM,EAP,Custom 3253607WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Strk Md/md,1,154, 146.30 ,150.92, 146.30 , 149.38 , 146.30 ,Current Medicare Rates,149.38,147.84,Included in per diem,146.3,Included in ER Case rate,146.3,146.3, 150.92 ,138.6
3253609WWM,EAP,Custom 3253609WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Strk Md/nar,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
3253792WWM,EAP,Custom 3253792WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Blade Strk Xl 19.5mm,1,212, 201.40 ,207.76, 201.40 , 205.64 , 201.40 ,Current Medicare Rates,205.64,203.52,Included in per diem,201.4,Included in ER Case rate,201.4,201.4, 207.76 ,190.8
3250425WWM,EAP,Custom 3250425WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bone Wax 2 31g,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3253930WWM,EAP,Custom 3253930WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Burr Clear#ar-8500coe,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253966WWM,EAP,Custom 3253966WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Burr Round #ar-7300rbe,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253112WWM,EAP,Custom 3253112WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bx Instr 14gx10cm,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
3253113WWM,EAP,Custom 3253113WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bx Instr 14gx16cm,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
3253791WWM,EAP,Custom 3253791WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Bx Needle 11g #jbc1211,1,394, 374.30 ,386.12, 374.30 , 382.18 , 374.30 ,Current Medicare Rates,382.18,378.24,Included in per diem,374.3,Included in ER Case rate,374.3,374.3, 386.12 ,354.6
3253938WWM,EAP,Custom 3253938WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula #ar-6592-08-50,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,Included in per diem,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
3253685WWM,EAP,Custom 3253685WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Low #ar-6548,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
3253797WWM,EAP,Custom 3253797WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Passport 6x30,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3253782WWM,EAP,Custom 3253782WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Passport 8x30,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,Included in per diem,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
3253746WWM,EAP,Custom 3253746WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Passport 8x40,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,Included in per diem,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
3253564WWM,EAP,Custom 3253564WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Twistin 7x7#ar,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
3253538WWM,EAP,Custom 3253538WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Twistin 8x7#ar,1,128, 121.60 ,125.44, 121.60 , 124.16 , 121.60 ,Current Medicare Rates,124.16,122.88,Included in per diem,121.6,Included in ER Case rate,121.6,121.6, 125.44 ,115.2
3253652WWM,EAP,Custom 3253652WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Twistin 8x9#ar,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
3253559WWM,EAP,Custom 3253559WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cannula Twistin Notch,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
3253968WWM,EAP,Custom 3253968WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath 18fr #361218,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
3253969WWM,EAP,Custom 3253969WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath 22 Fr #361222,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
3253970WWM,EAP,Custom 3253970WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath 26fr #361226,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
3253971WWM,EAP,Custom 3253971WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath 30fr # 361230,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
3253972WWM,EAP,Custom 3253972WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath 34fr #361234,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
3253973WWM,EAP,Custom 3253973WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath 36fr # 361236,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
3253351WWM,EAP,Custom 3253351WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath Cholan #2405-50,1,295, 280.25 ,289.1, 280.25 , 286.15 , 280.25 ,Current Medicare Rates,286.15,283.2,Included in per diem,280.25,Included in ER Case rate,280.25,280.25, 289.10 ,265.5
3252715WWM,EAP,Custom 3252715WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath Cholan16.5g#18305,1,204, 193.80 ,199.92, 193.80 , 197.88 , 193.80 ,Current Medicare Rates,197.88,195.84,Included in per diem,193.8,Included in ER Case rate,193.8,193.8, 199.92 ,183.6
3253732WWM,EAP,Custom 3253732WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath Fogarty 3fr#12a08,1,263, 249.85 ,257.74, 249.85 , 255.11 , 249.85 ,Current Medicare Rates,255.11,252.48,Included in per diem,249.85,Included in ER Case rate,249.85,249.85, 257.74 ,236.7
3253733WWM,EAP,Custom 3253733WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath Fogarty 4fr#12a08,1,263, 249.85 ,257.74, 249.85 , 255.11 , 249.85 ,Current Medicare Rates,255.11,252.48,Included in per diem,249.85,Included in ER Case rate,249.85,249.85, 257.74 ,236.7
3253734WWM,EAP,Custom 3253734WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath Fogarty 5fr#12a08,1,263, 249.85 ,257.74, 249.85 , 255.11 , 249.85 ,Current Medicare Rates,255.11,252.48,Included in per diem,249.85,Included in ER Case rate,249.85,249.85, 257.74 ,236.7
3252526WWM,EAP,Custom 3252526WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath Junostomy 16fr,1,566, 537.70 ,554.68, 537.70 , 549.02 , 537.70 ,Current Medicare Rates,549.02,543.36,Included in per diem,537.7,Included in ER Case rate,537.7,537.7, 554.68 ,509.4
3252525WWM,EAP,Custom 3252525WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cath Junostomy 7fr,1,444, 421.80 ,435.12, 421.80 , 430.68 , 421.80 ,Current Medicare Rates,430.68,426.24,Included in per diem,421.8,Included in ER Case rate,421.8,421.8, 435.12 ,399.6
3253579WWM,EAP,Custom 3253579WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Or Coban 4"" #m20845",1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
3252815WWM,EAP,Custom 3252815WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Colon Hot Snare#sd21ou,1,465, 441.75 ,455.7, 441.75 , 451.05 , 441.75 ,Current Medicare Rates,451.05,446.4,Included in per diem,441.75,Included in ER Case rate,441.75,441.75, 455.70 ,418.5
3253744WWM,EAP,Custom 3253744WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Colon Needle#nm-200u-0,1,146, 138.70 ,143.08, 138.70 , 141.62 , 138.70 ,Current Medicare Rates,141.62,140.16,Included in per diem,138.7,Included in ER Case rate,138.7,138.7, 143.08 ,131.4
3253551WWM,EAP,Custom 3253551WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Corkscrew Anch 3.5,1,701, 665.95 ,686.98, 665.95 , 679.97 , 665.95 ,Current Medicare Rates,679.97,672.96,Included in per diem,665.95,Included in ER Case rate,665.95,665.95, 686.98 ,630.9
3253537WWM,EAP,Custom 3253537WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Corkscrew Sut Anch,1,587, 557.65 ,575.26, 557.65 , 569.39 , 557.65 ,Current Medicare Rates,569.39,563.52,Included in per diem,557.65,Included in ER Case rate,557.65,557.65, 575.26 ,528.3
3253666WWM,EAP,Custom 3253666WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Corkscrew Sut Anch 5.5,1,855, 812.25 ,837.9, 812.25 , 829.35 , 812.25 ,Current Medicare Rates,829.35,820.8,Included in per diem,812.25,Included in ER Case rate,812.25,812.25, 837.90 ,769.5
3252975WWM,EAP,Custom 3252975WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Curette 7mm #279,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3252973WWM,EAP,Custom 3252973WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Curette Cvd 8mm #280,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
3252974WWM,EAP,Custom 3252974WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Curette Cvd 9mm #281,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
3252709WWM,EAP,Custom 3252709WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cutter Lin 55mm #tlc55,1,286, 271.70 ,280.28, 271.70 , 277.42 , 271.70 ,Current Medicare Rates,277.42,274.56,Included in per diem,271.7,Included in ER Case rate,271.7,271.7, 280.28 ,257.4
3253881WWM,EAP,Custom 3253881WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cutter Lin 75mm# Tlc75,1,438, 416.10 ,429.24, 416.10 , 424.86 , 416.10 ,Current Medicare Rates,424.86,420.48,Included in per diem,416.1,Included in ER Case rate,416.1,416.1, 429.24 ,394.2
3253882WWM,EAP,Custom 3253882WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cutter Lin Reload#tcr7,1,272, 258.40 ,266.56, 258.40 , 263.84 , 258.40 ,Current Medicare Rates,263.84,261.12,Included in per diem,258.4,Included in ER Case rate,258.4,258.4, 266.56 ,244.8
3252710WWM,EAP,Custom 3252710WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Cutter Lin Reloadtcr55,1,183, 173.85 ,179.34, 173.85 , 177.51 , 173.85 ,Current Medicare Rates,177.51,175.68,Included in per diem,173.85,Included in ER Case rate,173.85,173.85, 179.34 ,164.7
3253641WWM,EAP,Custom 3253641WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Dbl Armed Needle#8535,1,148, 140.60 ,145.04, 140.60 , 143.56 , 140.60 ,Current Medicare Rates,143.56,142.08,Included in per diem,140.6,Included in ER Case rate,140.6,140.6, 145.04 ,133.2
3253916WWM,EAP,Custom 3253916WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Dissect Cur#ar-8400cds,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253965WWM,EAP,Custom 3253965WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Dissector # Ar-7300ds,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253788WWM,EAP,Custom 3253788WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Flat 15fr# Su130,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
3253606WWM,EAP,Custom 3253606WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Jp 10fr#su130132,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3250671WWM,EAP,Custom 3250671WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Jp 15fr,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3250672WWM,EAP,Custom 3250672WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Jp 19fr,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
3253055WWM,EAP,Custom 3253055WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Jp 7 Fr,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252645WWM,EAP,Custom 3252645WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Jp 7fr #u1301330,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3252750WWM,EAP,Custom 3252750WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Jp Fh 10mm #1309,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253631WWM,EAP,Custom 3253631WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Jp Rnd 15fr,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3252785WWM,EAP,Custom 3252785WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drain Tls 7fr #6640,1,153, 145.35 ,149.94, 145.35 , 148.41 , 145.35 ,Current Medicare Rates,148.41,146.88,Included in per diem,145.35,Included in ER Case rate,145.35,145.35, 149.94 ,137.7
3254010WWM,EAP,Custom 3254010WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Acutrak#at2-2515,1,667, 633.65 ,653.66, 633.65 , 646.99 , 633.65 ,Current Medicare Rates,646.99,640.32,Included in per diem,633.65,Included in ER Case rate,633.65,633.65, 653.66 ,600.3
3253932WWM,EAP,Custom 3253932WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit #ar-8943-16,1,245, 232.75 ,240.1, 232.75 , 237.65 , 232.75 ,Current Medicare Rates,237.65,235.2,Included in per diem,232.75,Included in ER Case rate,232.75,232.75, 240.10 ,220.5
3254044WWM,EAP,Custom 3254044WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit #dc6106,1,348, 330.60 ,341.04, 330.60 , 337.56 , 330.60 ,Current Medicare Rates,337.56,334.08,Included in per diem,330.6,Included in ER Case rate,330.6,330.6, 341.04 ,313.2
3254003WWM,EAP,Custom 3254003WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit 1.8#310-509,1,457, 434.15 ,447.86, 434.15 , 443.29 , 434.15 ,Current Medicare Rates,443.29,438.72,Included in per diem,434.15,Included in ER Case rate,434.15,434.15, 447.86 ,411.3
3253953WWM,EAP,Custom 3253953WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit 2.0# Fdb20,1,303, 287.85 ,296.94, 287.85 , 293.91 , 287.85 ,Current Medicare Rates,293.91,290.88,Included in per diem,287.85,Included in ER Case rate,287.85,287.85, 296.94 ,272.7
3253951WWM,EAP,Custom 3253951WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit 2.5# Db25,1,303, 287.85 ,296.94, 287.85 , 293.91 , 287.85 ,Current Medicare Rates,293.91,290.88,Included in per diem,287.85,Included in ER Case rate,287.85,287.85, 296.94 ,272.7
3253909WWM,EAP,Custom 3253909WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit 2.5#ar-8943-,1,217, 206.15 ,212.66, 206.15 , 210.49 , 206.15 ,Current Medicare Rates,210.49,208.32,Included in per diem,206.15,Included in ER Case rate,206.15,206.15, 212.66 ,195.3
3253910WWM,EAP,Custom 3253910WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit 3.5#ar-4160-,1,203, 192.85 ,198.94, 192.85 , 196.91 , 192.85 ,Current Medicare Rates,196.91,194.88,Included in per diem,192.85,Included in ER Case rate,192.85,192.85, 198.94 ,182.7
3253612WWM,EAP,Custom 3253612WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit 4.5#4806-145,1,190, 180.50 ,186.2, 180.50 , 184.30 , 180.50 ,Current Medicare Rates,184.3,182.4,Included in per diem,180.5,Included in ER Case rate,180.5,180.5, 186.20 ,171
3253907WWM,EAP,Custom 3253907WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit Cali 2.5#ar-,1,217, 206.15 ,212.66, 206.15 , 210.49 , 206.15 ,Current Medicare Rates,210.49,208.32,Included in per diem,206.15,Included in ER Case rate,206.15,206.15, 212.66 ,195.3
3253908WWM,EAP,Custom 3253908WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Bit Cann 2.6#ar-,1,295, 280.25 ,289.1, 280.25 , 286.15 , 280.25 ,Current Medicare Rates,286.15,283.2,Included in per diem,280.25,Included in ER Case rate,280.25,280.25, 289.10 ,265.5
3254125WWM,EAP,Custom 3254125WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Cann 9.5mm #ar-1218-95,1,593, 563.35 ,581.14, 563.35 , 575.21 , 563.35 ,Current Medicare Rates,575.21,569.28,Included in per diem,563.35,Included in ER Case rate,563.35,563.35, 581.14 ,533.7
3253684WWM,EAP,Custom 3253684WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Drill Pushlock 3.5,1,245, 232.75 ,240.1, 232.75 , 237.65 , 232.75 ,Current Medicare Rates,237.65,235.2,Included in per diem,232.75,Included in ER Case rate,232.75,232.75, 240.10 ,220.5
3253952WWM,EAP,Custom 3253952WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Dvr Anatomic# Dvranl,1,"1,915.00"," 1,819.25 ",1876.7," 1,819.25 "," 1,857.55 "," 1,819.25 ",Current Medicare Rates,1857.55,1838.4,Included in per diem,1819.25,Included in ER Case rate,1819.25,1819.25," 1,876.70 ",1723.5
3253438WWM,EAP,Custom 3253438WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endo Clip Applier Lg,1,646, 613.70 ,633.08, 613.70 , 626.62 , 613.70 ,Current Medicare Rates,626.62,620.16,Included in per diem,613.7,Included in ER Case rate,613.7,613.7, 633.08 ,581.4
3253717WWM,EAP,Custom 3253717WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endo Cutter 35#atb35,1,594, 564.30 ,582.12, 564.30 , 576.18 , 564.30 ,Current Medicare Rates,576.18,570.24,Included in per diem,564.3,Included in ER Case rate,564.3,564.3, 582.12 ,534.6
3253718WWM,EAP,Custom 3253718WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endo Cutter 45 #ats45,1,630, 598.50 ,617.4, 598.50 , 611.10 , 598.50 ,Current Medicare Rates,611.1,604.8,Included in per diem,598.5,Included in ER Case rate,598.5,598.5, 617.40 ,567
3253747WWM,EAP,Custom 3253747WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endo Cutter 45#ets45,1,374, 355.30 ,366.52, 355.30 , 362.78 , 355.30 ,Current Medicare Rates,362.78,359.04,Included in per diem,355.3,Included in ER Case rate,355.3,355.3, 366.52 ,336.6
3253831WWM,EAP,Custom 3253831WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endo Cutter#ec45a,1,988, 938.60 ,968.24, 938.60 , 958.36 , 938.60 ,Current Medicare Rates,958.36,948.48,Included in per diem,938.6,Included in ER Case rate,938.6,938.6, 968.24 ,889.2
3253842WWM,EAP,Custom 3253842WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endo Flex 45mm #sc45a,1,988, 938.60 ,968.24, 938.60 , 958.36 , 938.60 ,Current Medicare Rates,958.36,948.48,Included in per diem,938.6,Included in ER Case rate,938.6,938.6, 968.24 ,889.2
3253913WWM,EAP,Custom 3253913WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endo Reload 45m#ecr45d,1,347, 329.65 ,340.06, 329.65 , 336.59 , 329.65 ,Current Medicare Rates,336.59,333.12,Included in per diem,329.65,Included in ER Case rate,329.65,329.65, 340.06 ,312.3
3252840WWM,EAP,Custom 3252840WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endopouch Retrv#pouch,1,228, 216.60 ,223.44, 216.60 , 221.16 , 216.60 ,Current Medicare Rates,221.16,218.88,Included in per diem,216.6,Included in ER Case rate,216.6,216.6, 223.44 ,205.2
3253846WWM,EAP,Custom 3253846WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endostitch 10mm#173016,1,642, 609.90 ,629.16, 609.90 , 622.74 , 609.90 ,Current Medicare Rates,622.74,616.32,Included in per diem,609.9,Included in ER Case rate,609.9,609.9, 629.16 ,577.8
3253847WWM,EAP,Custom 3253847WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Endostitch Su #170052,1,185, 175.75 ,181.3, 175.75 , 179.45 , 175.75 ,Current Medicare Rates,179.45,177.6,Included in per diem,175.75,Included in ER Case rate,175.75,175.75, 181.30 ,166.5
3253849WWM,EAP,Custom 3253849WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Enseal Rnd 5mm#nseal53,1,881, 836.95 ,863.38, 836.95 , 854.57 , 836.95 ,Current Medicare Rates,854.57,845.76,Included in per diem,836.95,Included in ER Case rate,836.95,836.95, 863.38 ,792.9
3253967WWM,EAP,Custom 3253967WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Enseal Tissue#nsealx22,1,"1,340.00"," 1,273.00 ",1313.2," 1,273.00 "," 1,299.80 "," 1,273.00 ",Current Medicare Rates,1299.8,1286.4,Included in per diem,1273,Included in ER Case rate,1273,1273," 1,313.20 ",1206
3253963WWM,EAP,Custom 3253963WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Enseal Trio #etrio325h,1,816, 775.20 ,799.68, 775.20 , 791.52 , 775.20 ,Current Medicare Rates,791.52,783.36,Included in per diem,775.2,Included in ER Case rate,775.2,775.2, 799.68 ,734.4
3253914WWM,EAP,Custom 3253914WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Enseal Trio #etrio345h,1,1088," 1,033.60 ",1066.24," 1,033.60 "," 1,055.36 "," 1,033.60 ",Current Medicare Rates,1055.36,1044.48,Included in per diem,1033.6,Included in ER Case rate,1033.6,1033.6," 1,066.24 ",979.2
3253886WWM,EAP,Custom 3253886WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Enseal Trio# Etrio335h,1,978, 929.10 ,958.44, 929.10 , 948.66 , 929.10 ,Current Medicare Rates,948.66,938.88,Included in per diem,929.1,Included in ER Case rate,929.1,929.1, 958.44 ,880.2
3253542WWM,EAP,Custom 3253542WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Esmark 6x9,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
3253723WWM,EAP,Custom 3253723WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Esoph Dil Ball 15#g319,1,478, 454.10 ,468.44, 454.10 , 463.66 , 454.10 ,Current Medicare Rates,463.66,458.88,Included in per diem,454.1,Included in ER Case rate,454.1,454.1, 468.44 ,430.2
3253743WWM,EAP,Custom 3253743WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Esoph Dil Ball 18#g487,1,478, 454.10 ,468.44, 454.10 , 463.66 , 454.10 ,Current Medicare Rates,463.66,458.88,Included in per diem,454.1,Included in ER Case rate,454.1,454.1, 468.44 ,430.2
3253724WWM,EAP,Custom 3253724WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Esoph Dilat Syr #ds-60,1,170, 161.50 ,166.6, 161.50 , 164.90 , 161.50 ,Current Medicare Rates,164.9,163.2,Included in per diem,161.5,Included in ER Case rate,161.5,161.5, 166.60 ,153
3253929WWM,EAP,Custom 3253929WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Excalibur# Ar-8400ex,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253644WWM,EAP,Custom 3253644WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Fiber Tape #ar7237-7,1,172, 163.40 ,168.56, 163.40 , 166.84 , 163.40 ,Current Medicare Rates,166.84,165.12,Included in per diem,163.4,Included in ER Case rate,163.4,163.4, 168.56 ,154.8
3253665WWM,EAP,Custom 3253665WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Fiberlink #ar7235,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3254130WWM,EAP,Custom 3254130WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Fiberloop #2 Blue #ar-7234,1,213, 202.35 ,208.74, 202.35 , 206.61 , 202.35 ,Current Medicare Rates,206.61,204.48,Included in per diem,202.35,Included in ER Case rate,202.35,202.35, 208.74 ,191.7
3253975WWM,EAP,Custom 3253975WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Fiberloop #ar7234c,1,172, 163.40 ,168.56, 163.40 , 166.84 , 163.40 ,Current Medicare Rates,166.84,165.12,Included in per diem,163.4,Included in ER Case rate,163.4,163.4, 168.56 ,154.8
3253576WWM,EAP,Custom 3253576WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Fiberstick #2#ar-7209,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3253946WWM,EAP,Custom 3253946WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Fiberwire 2-0#ar-7220,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
3254047WWM,EAP,Custom 3254047WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Flipcutter #ar-1204af,1,890, 845.50 ,872.2, 845.50 , 863.30 , 845.50 ,Current Medicare Rates,863.3,854.4,Included in per diem,845.5,Included in ER Case rate,845.5,845.5, 872.20 ,801
3253146WWM,EAP,Custom 3253146WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Forcep Colon#fb-230u.b,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
3252547WWM,EAP,Custom 3252547WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Forcep Dishotbi#fd230u,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
3253145WWM,EAP,Custom 3253145WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Forcep Egd #fb-230k.b,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
3253546WWM,EAP,Custom 3253546WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Frazier Suct 10fr#1660,1,20, 19.00 ,19.6, 19.00 , 19.40 , 19.00 ,Current Medicare Rates,19.4,19.2,Included in per diem,19,Included in ER Case rate,19,19, 19.60 ,18
3253305WWM,EAP,Custom 3253305WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Gia 55 Gia8038s,1,851, 808.45 ,833.98, 808.45 , 825.47 , 808.45 ,Current Medicare Rates,825.47,816.96,Included in per diem,808.45,Included in ER Case rate,808.45,808.45, 833.98 ,765.9
3253306WWM,EAP,Custom 3253306WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Gia 55 Reload Gia8038l,1,647, 614.65 ,634.06, 614.65 , 627.59 , 614.65 ,Current Medicare Rates,627.59,621.12,Included in per diem,614.65,Included in ER Case rate,614.65,614.65, 634.06 ,582.3
3253689WWM,EAP,Custom 3253689WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Graft 8 Layer 13x15,1,"4,476.00"," 4,252.20 ",4386.48," 4,252.20 "," 4,341.72 "," 4,252.20 ",Current Medicare Rates,4341.72,4296.96,Included in per diem,4252.2,Included in ER Case rate,4252.2,4252.2," 4,386.48 ",4028.4
3253875WWM,EAP,Custom 3253875WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Graft Blade # Gb228rs,1,93, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,Included in per diem,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
3253876WWM,EAP,Custom 3253876WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Graft Carr 1:1.5# Ba72,1,154, 146.30 ,150.92, 146.30 , 149.38 , 146.30 ,Current Medicare Rates,149.38,147.84,Included in per diem,146.3,Included in ER Case rate,146.3,146.3, 150.92 ,138.6
3254128WWM,EAP,Custom 3254128WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Graftbolt Tibial 8mm #ar-5100-08,1,960, 912.00 ,940.8, 912.00 , 931.20 , 912.00 ,Current Medicare Rates,931.2,921.6,Included in per diem,912,Included in ER Case rate,912,912, 940.80 ,864
3254129WWM,EAP,Custom 3254129WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Graftbolt Tibial 9mm #ar-5100-09,1,960, 912.00 ,940.8, 912.00 , 931.20 , 912.00 ,Current Medicare Rates,931.2,921.6,Included in per diem,912,Included in ER Case rate,912,912, 940.80 ,864
3254054WWM,EAP,Custom 3254054WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Grasper Fb #00711175,1,348, 330.60 ,341.04, 330.60 , 337.56 , 330.60 ,Current Medicare Rates,337.56,334.08,Included in per diem,330.6,Included in ER Case rate,330.6,330.6, 341.04 ,313.2
3252924WWM,EAP,Custom 3252924WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Groshong 9.5fr#7726952,1,987, 937.65 ,967.26, 937.65 , 957.39 , 937.65 ,Current Medicare Rates,957.39,947.52,Included in per diem,937.65,Included in ER Case rate,937.65,937.65, 967.26 ,888.3
3253071WWM,EAP,Custom 3253071WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Guide Wire,1,715, 679.25 ,700.7, 679.25 , 693.55 , 679.25 ,Current Medicare Rates,693.55,686.4,Included in per diem,679.25,Included in ER Case rate,679.25,679.25, 700.70 ,643.5
3253553WWM,EAP,Custom 3253553WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Guidepin 2.4#1147-91,1,210, 199.50 ,205.8, 199.50 , 203.70 , 199.50 ,Current Medicare Rates,203.7,201.6,Included in per diem,199.5,Included in ER Case rate,199.5,199.5, 205.80 ,189
3253911WWM,EAP,Custom 3253911WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Guidewire 1.35mm#ar-89,1,119, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3253798WWM,EAP,Custom 3253798WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Harmonic Ace #har36,1,1109," 1,053.55 ",1086.82," 1,053.55 "," 1,075.73 "," 1,053.55 ",Current Medicare Rates,1075.73,1064.64,Included in per diem,1053.55,Included in ER Case rate,1053.55,1053.55," 1,086.82 ",998.1
3253801WWM,EAP,Custom 3253801WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Harmonic Focus # Fcs9,1,1094," 1,039.30 ",1072.12," 1,039.30 "," 1,061.18 "," 1,039.30 ",Current Medicare Rates,1061.18,1050.24,Included in per diem,1039.3,Included in ER Case rate,1039.3,1039.3," 1,072.12 ",984.6
3253688WWM,EAP,Custom 3253688WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Hip Pushlock 3.5,1,447, 424.65 ,438.06, 424.65 , 433.59 , 424.65 ,Current Medicare Rates,433.59,429.12,Included in per diem,424.65,Included in ER Case rate,424.65,424.65, 438.06 ,402.3
3253329WWM,EAP,Custom 3253329WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ils Crvd #cdh25,1,770, 731.50 ,754.6, 731.50 , 746.90 , 731.50 ,Current Medicare Rates,746.9,739.2,Included in per diem,731.5,Included in ER Case rate,731.5,731.5, 754.60 ,693
3253330WWM,EAP,Custom 3253330WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ils Crvd #cdh29,1,802, 761.90 ,785.96, 761.90 , 777.94 , 761.90 ,Current Medicare Rates,777.94,769.92,Included in per diem,761.9,Included in ER Case rate,761.9,761.9, 785.96 ,721.8
3253331WWM,EAP,Custom 3253331WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ils Crvd #cdh33,1,770, 731.50 ,754.6, 731.50 , 746.90 , 731.50 ,Current Medicare Rates,746.9,739.2,Included in per diem,731.5,Included in ER Case rate,731.5,731.5, 754.60 ,693
3252531WWM,EAP,Custom 3252531WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ils Strght #sdh25,1,697, 662.15 ,683.06, 662.15 , 676.09 , 662.15 ,Current Medicare Rates,676.09,669.12,Included in per diem,662.15,Included in ER Case rate,662.15,662.15, 683.06 ,627.3
3252530WWM,EAP,Custom 3252530WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ils Strght #sdh29,1,821, 779.95 ,804.58, 779.95 , 796.37 , 779.95 ,Current Medicare Rates,796.37,788.16,Included in per diem,779.95,Included in ER Case rate,779.95,779.95, 804.58 ,738.9
3252535WWM,EAP,Custom 3252535WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Ils Strght #sdh33,1,747, 709.65 ,732.06, 709.65 , 724.59 , 709.65 ,Current Medicare Rates,724.59,717.12,Included in per diem,709.65,Included in ER Case rate,709.65,709.65, 732.06 ,672.3
3253541WWM,EAP,Custom 3253541WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Imperv Stockinette,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3253183WWM,EAP,Custom 3253183WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Introducer 10fr 060111,1,214, 203.30 ,209.72, 203.30 , 207.58 , 203.30 ,Current Medicare Rates,207.58,205.44,Included in per diem,203.3,Included in ER Case rate,203.3,203.3, 209.72 ,192.6
3250095WWM,EAP,Custom 3250095WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Introducer 8.5#0603180,1,258, 245.10 ,252.84, 245.10 , 250.26 , 245.10 ,Current Medicare Rates,250.26,247.68,Included in per diem,245.1,Included in ER Case rate,245.1,245.1, 252.84 ,232.2
3254095WWM,EAP,HCPCS 0191T,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Istent,1,"4,620.00"," 4,389.00 ",4527.6," 4,389.00 "," 4,481.40 "," 4,389.00 ",Current Medicare Rates,4481.4,4435.2,Included in per diem,4389,Included in ER Case rate,4389,4389," 4,527.60 ",4158
3253366WWM,EAP,Custom 3253366WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Jp 10mm W/trocar #su13,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
3253367WWM,EAP,Custom 3253367WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Jp 7mm #su130-1310,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253365WWM,EAP,Custom 3253365WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Jp 7mm W/trocar #su130,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
3252789WWM,EAP,Custom 3252789WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Jp Resvr    #su1301305,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3253959WWM,EAP,Custom 3253959WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K Wire 1.6 #kw062ss,1,128, 121.60 ,125.44, 121.60 , 124.16 , 121.60 ,Current Medicare Rates,124.16,122.88,Included in per diem,121.6,Included in ER Case rate,121.6,121.6, 125.44 ,115.2
3253240WWM,EAP,Custom 3253240WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K-wire 0.6 #292.06,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3253241WWM,EAP,Custom 3253241WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K-wire 0.8 #292.08,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3253242WWM,EAP,Custom 3253242WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K-wire 1.0 #292.10,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
3254045WWM,EAP,Custom 3254045WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K-wire 1.1 #no2228012,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
3253243WWM,EAP,Custom 3253243WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K-wire 1.25 #292.12,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
3254004WWM,EAP,Custom 3254004WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K-wire 1.25#292-12e,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
3253244WWM,EAP,Custom 3253244WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or K-wire 1.6 #292.16,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
3253924WWM,EAP,Custom 3253924WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Lasso L 45#ar-6068-45l,1,408, 387.60 ,399.84, 387.60 , 395.76 , 387.60 ,Current Medicare Rates,395.76,391.68,Included in per diem,387.6,Included in ER Case rate,387.6,387.6, 399.84 ,367.2
3253928WWM,EAP,Custom 3253928WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Lasso L 90#ar-6068-90l,1,408, 387.60 ,399.84, 387.60 , 395.76 , 387.60 ,Current Medicare Rates,395.76,391.68,Included in per diem,387.6,Included in ER Case rate,387.6,387.6, 399.84 ,367.2
3253921WWM,EAP,Custom 3253921WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Lasso R 45#ar-6068-45r,1,408, 387.60 ,399.84, 387.60 , 395.76 , 387.60 ,Current Medicare Rates,395.76,391.68,Included in per diem,387.6,Included in ER Case rate,387.6,387.6, 399.84 ,367.2
3253922WWM,EAP,Custom 3253922WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Lasso R 90#ar-6068-90r,1,408, 387.60 ,399.84, 387.60 , 395.76 , 387.60 ,Current Medicare Rates,395.76,391.68,Included in per diem,387.6,Included in ER Case rate,387.6,387.6, 399.84 ,367.2
3253925WWM,EAP,Custom 3253925WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Lasso St 90#ar-6068-90,1,408, 387.60 ,399.84, 387.60 , 395.76 , 387.60 ,Current Medicare Rates,395.76,391.68,Included in per diem,387.6,Included in ER Case rate,387.6,387.6, 399.84 ,367.2
3253884WWM,EAP,Custom 3253884WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Linear Stapler # Ax55b,1,592, 562.40 ,580.16, 562.40 , 574.24 , 562.40 ,Current Medicare Rates,574.24,568.32,Included in per diem,562.4,Included in ER Case rate,562.4,562.4, 580.16 ,532.8
3253979WWM,EAP,Custom 3253979WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Meniscal Cinch#ar-4500,1,837, 795.15 ,820.26, 795.15 , 811.89 , 795.15 ,Current Medicare Rates,811.89,803.52,Included in per diem,795.15,Included in ER Case rate,795.15,795.15, 820.26 ,753.3
3253748WWM,EAP,Custom 3253748WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Needle Veress #007.00,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
3253686WWM,EAP,Custom 3253686WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Net Foreign Body# 00711152,1,245, 232.75 ,240.1, 232.75 , 237.65 , 232.75 ,Current Medicare Rates,237.65,235.2,Included in per diem,232.75,Included in ER Case rate,232.75,232.75, 240.10 ,220.5
3253857WWM,EAP,Custom 3253857WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Occluder #cpo-6,1,253, 240.35 ,247.94, 240.35 , 245.41 , 240.35 ,Current Medicare Rates,245.41,242.88,Included in per diem,240.35,Included in ER Case rate,240.35,240.35, 247.94 ,227.7
3252605WWM,EAP,Custom 3252605WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Orthosorb 1.3mm 841052,1,593, 563.35 ,581.14, 563.35 , 575.21 , 563.35 ,Current Medicare Rates,575.21,569.28,Included in per diem,563.35,Included in ER Case rate,563.35,563.35, 581.14 ,533.7
3252600WWM,EAP,Custom 3252600WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Orthosorb 2.0mm 842052,1,362, 343.90 ,354.76, 343.90 , 351.14 , 343.90 ,Current Medicare Rates,351.14,347.52,Included in per diem,343.9,Included in ER Case rate,343.9,343.9, 354.76 ,325.8
3250288WWM,EAP,Custom 3250288WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Pain Pump 100 Ml,1,306, 290.70 ,299.88, 290.70 , 296.82 , 290.70 ,Current Medicare Rates,296.82,293.76,Included in per diem,290.7,Included in ER Case rate,290.7,290.7, 299.88 ,275.4
3250281WWM,EAP,Custom 3250281WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Pain Pump 270 Ml,1,408, 387.60 ,399.84, 387.60 , 395.76 , 387.60 ,Current Medicare Rates,395.76,391.68,Included in per diem,387.6,Included in ER Case rate,387.6,387.6, 399.84 ,367.2
3253895WWM,EAP,Custom 3253895WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peek Corkscrew 4.5#ar-,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,Included in per diem,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
3253894WWM,EAP,Custom 3253894WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peek Pushloc#ar-1923ps,1,867, 823.65 ,849.66, 823.65 , 840.99 , 823.65 ,Current Medicare Rates,840.99,832.32,Included in per diem,823.65,Included in ER Case rate,823.65,823.65, 849.66 ,780.3
3253954WWM,EAP,Custom 3253954WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peg Full 2.5x16# Fp16,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
3253955WWM,EAP,Custom 3253955WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peg Full 2.5x18# Fp18,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
3253957WWM,EAP,Custom 3253957WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peg Full 2.5x22 #fp22,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
3253958WWM,EAP,Custom 3253958WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peg Full 2.5x26 #fp26,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
3253960WWM,EAP,Custom 3253960WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peg Thread #1312-11-124,1,488, 463.60 ,478.24, 463.60 , 473.36 , 463.60 ,Current Medicare Rates,473.36,468.48,Included in per diem,463.6,Included in ER Case rate,463.6,463.6, 478.24 ,439.2
3253961WWM,EAP,Custom 3253961WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peg Thread #1312-11-126,1,488, 463.60 ,478.24, 463.60 , 473.36 , 463.60 ,Current Medicare Rates,473.36,468.48,Included in per diem,463.6,Included in ER Case rate,463.6,463.6, 478.24 ,439.2
3253712WWM,EAP,Custom 3253712WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Peg Tube 24#peg24push,1,314, 298.30 ,307.72, 298.30 , 304.58 , 298.30 ,Current Medicare Rates,304.58,301.44,Included in per diem,298.3,Included in ER Case rate,298.3,298.3, 307.72 ,282.6
3254043WWM,EAP,Custom 3254043WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Pin 1.1mm #dc4212,1,209, 198.55 ,204.82, 198.55 , 202.73 , 198.55 ,Current Medicare Rates,202.73,200.64,Included in per diem,198.55,Included in ER Case rate,198.55,198.55, 204.82 ,188.1
3253998WWM,EAP,Custom 3253998WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate #02-111-531,1,"2,230.00"," 2,118.50 ",2185.4," 2,118.50 "," 2,163.10 "," 2,118.50 ",Current Medicare Rates,2163.1,2140.8,Included in per diem,2118.5,Included in ER Case rate,2118.5,2118.5," 2,185.40 ",2007
3253976WWM,EAP,Custom 3253976WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate #ar8943br-04,1,"1,505.00"," 1,429.75 ",1474.9," 1,429.75 "," 1,459.85 "," 1,429.75 ",Current Medicare Rates,1459.85,1444.8,Included in per diem,1429.75,Included in ER Case rate,1429.75,1429.75," 1,474.90 ",1354.5
3254013WWM,EAP,Custom 3254013WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate 10 Hole#ar8943c,1,1139," 1,082.05 ",1116.22," 1,082.05 "," 1,104.83 "," 1,082.05 ",Current Medicare Rates,1104.83,1093.44,Included in per diem,1082.05,Included in ER Case rate,1082.05,1082.05," 1,116.22 ",1025.1
3253931WWM,EAP,Custom 3253931WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate 4 Hole#ar-8943bl,1,"1,209.00"," 1,148.55 ",1184.82," 1,148.55 "," 1,172.73 "," 1,148.55 ",Current Medicare Rates,1172.73,1160.64,Included in per diem,1148.55,Included in ER Case rate,1148.55,1148.55," 1,184.82 ",1088.1
3253993WWM,EAP,Custom 3253993WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate 4 Hole#ar-8943br,1,"1,505.00"," 1,429.75 ",1474.9," 1,429.75 "," 1,459.85 "," 1,429.75 ",Current Medicare Rates,1459.85,1444.8,Included in per diem,1429.75,Included in ER Case rate,1429.75,1429.75," 1,474.90 ",1354.5
3253990WWM,EAP,Custom 3253990WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate 7 Hole #ar-8943c,1,"1,435.00"," 1,363.25 ",1406.3," 1,363.25 "," 1,391.95 "," 1,363.25 ",Current Medicare Rates,1391.95,1377.6,Included in per diem,1363.25,Included in ER Case rate,1363.25,1363.25," 1,406.30 ",1291.5
3253901WWM,EAP,Custom 3253901WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate 7 Hole#ar-8943t-,1,932, 885.40 ,913.36, 885.40 , 904.04 , 885.40 ,Current Medicare Rates,904.04,894.72,Included in per diem,885.4,Included in ER Case rate,885.4,885.4, 913.36 ,838.8
3254051WWM,EAP,Custom 3254051WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Plate Loc #ar8943t-08,1,967, 918.65 ,947.66, 918.65 , 937.99 , 918.65 ,Current Medicare Rates,937.99,928.32,Included in per diem,918.65,Included in ER Case rate,918.65,918.65, 947.66 ,870.3
3253692WWM,EAP,Custom 3253692WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Polyp Trap #00711099,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
3253883WWM,EAP,Custom 3253883WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Power Port # 1806060,1,890, 845.50 ,872.2, 845.50 , 863.30 , 845.50 ,Current Medicare Rates,863.3,854.4,Included in per diem,845.5,Included in ER Case rate,845.5,845.5, 872.20 ,801
3252522WWM,EAP,Custom 3252522WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Purse String #20242,1,431, 409.45 ,422.38, 409.45 , 418.07 , 409.45 ,Current Medicare Rates,418.07,413.76,Included in per diem,409.45,Included in ER Case rate,409.45,409.45, 422.38 ,387.9
3253923WWM,EAP,Custom 3253923WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Pushloc Kit#ar-1923ds,1,447, 424.65 ,438.06, 424.65 , 433.59 , 424.65 ,Current Medicare Rates,433.59,429.12,Included in per diem,424.65,Included in ER Case rate,424.65,424.65, 438.06 ,402.3
3253947WWM,EAP,Custom 3253947WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Pushloc Mini#ar1322dsl,1,447, 424.65 ,438.06, 424.65 , 433.59 , 424.65 ,Current Medicare Rates,433.59,429.12,Included in per diem,424.65,Included in ER Case rate,424.65,424.65, 438.06 ,402.3
3253948WWM,EAP,Custom 3253948WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Pushloc Peek#ar8825p,1,867, 823.65 ,849.66, 823.65 , 840.99 , 823.65 ,Current Medicare Rates,840.99,832.32,Included in per diem,823.65,Included in ER Case rate,823.65,823.65, 849.66 ,780.3
3253869WWM,EAP,Custom 3253869WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer 6mm #ar1450,1,524, 497.80 ,513.52, 497.80 , 508.28 , 497.80 ,Current Medicare Rates,508.28,503.04,Included in per diem,497.8,Included in ER Case rate,497.8,497.8, 513.52 ,471.6
3253942WWM,EAP,Custom 3253942WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer Core#ar-1224s,1,601, 570.95 ,588.98, 570.95 , 582.97 , 570.95 ,Current Medicare Rates,582.97,576.96,Included in per diem,570.95,Included in ER Case rate,570.95,570.95, 588.98 ,540.9
3254012WWM,EAP,Custom 3254012WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer Head# Ar-1408,1,549, 521.55 ,538.02, 521.55 , 532.53 , 521.55 ,Current Medicare Rates,532.53,527.04,Included in per diem,521.55,Included in ER Case rate,521.55,521.55, 538.02 ,494.1
3253944WWM,EAP,Custom 3253944WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer Head#ar-1407,1,549, 521.55 ,538.02, 521.55 , 532.53 , 521.55 ,Current Medicare Rates,532.53,527.04,Included in per diem,521.55,Included in ER Case rate,521.55,521.55, 538.02 ,494.1
3253920WWM,EAP,Custom 3253920WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer Head#ar-1407.5,1,549, 521.55 ,538.02, 521.55 , 532.53 , 521.55 ,Current Medicare Rates,532.53,527.04,Included in per diem,521.55,Included in ER Case rate,521.55,521.55, 538.02 ,494.1
3253978WWM,EAP,Custom 3253978WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer Low #ar1409lp,1,713, 677.35 ,698.74, 677.35 , 691.61 , 677.35 ,Current Medicare Rates,691.61,684.48,Included in per diem,677.35,Included in ER Case rate,677.35,677.35, 698.74 ,641.7
3254126WWM,EAP,Custom 3254126WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer Low #ar1409lp-90,1,593, 563.35 ,581.14, 563.35 , 575.21 , 563.35 ,Current Medicare Rates,575.21,569.28,Included in per diem,563.35,Included in ER Case rate,563.35,563.35, 581.14 ,533.7
3253943WWM,EAP,Custom 3253943WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reamer Low# Ar-1410lp,1,571, 542.45 ,559.58, 542.45 , 553.87 , 542.45 ,Current Medicare Rates,553.87,548.16,Included in per diem,542.45,Included in ER Case rate,542.45,542.45, 559.58 ,513.9
3252549WWM,EAP,Custom 3252549WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Rectal Tube 30fr 056130,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
3254105WWM,EAP,Custom 3254105WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reload Hernia #174007,1,328, 311.60 ,321.44, 311.60 , 318.16 , 311.60 ,Current Medicare Rates,318.16,314.88,Included in per diem,311.6,Included in ER Case rate,311.6,311.6, 321.44 ,295.2
3253833WWM,EAP,Custom 3253833WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reload Reg #ecr45b,1,347, 329.65 ,340.06, 329.65 , 336.59 , 329.65 ,Current Medicare Rates,336.59,333.12,Included in per diem,329.65,Included in ER Case rate,329.65,329.65, 340.06 ,312.3
3253720WWM,EAP,Custom 3253720WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reload Reg 35 #tr35b,1,291, 276.45 ,285.18, 276.45 , 282.27 , 276.45 ,Current Medicare Rates,282.27,279.36,Included in per diem,276.45,Included in ER Case rate,276.45,276.45, 285.18 ,261.9
3253722WWM,EAP,Custom 3253722WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reload Reg 45 #6r45b,1,308, 292.60 ,301.84, 292.60 , 298.76 , 292.60 ,Current Medicare Rates,298.76,295.68,Included in per diem,292.6,Included in ER Case rate,292.6,292.6, 301.84 ,277.2
3253832WWM,EAP,Custom 3253832WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reload Vasc #ecr45w,1,347, 329.65 ,340.06, 329.65 , 336.59 , 329.65 ,Current Medicare Rates,336.59,333.12,Included in per diem,329.65,Included in ER Case rate,329.65,329.65, 340.06 ,312.3
3253719WWM,EAP,Custom 3253719WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reload Vasc 35#tr35w,1,299, 284.05 ,293.02, 284.05 , 290.03 , 284.05 ,Current Medicare Rates,290.03,287.04,Included in per diem,284.05,Included in ER Case rate,284.05,284.05, 293.02 ,269.1
3254106WWM,EAP,Custom 3254106WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Reload Vasc 45 #tr45w,1,295, 280.25 ,289.1, 280.25 , 286.15 , 280.25 ,Current Medicare Rates,286.15,283.2,Included in per diem,280.25,Included in ER Case rate,280.25,280.25, 289.10 ,265.5
3253687WWM,EAP,Custom 3253687WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Roth Net Food Bolus,1,245, 232.75 ,240.1, 232.75 , 237.65 , 232.75 ,Current Medicare Rates,237.65,235.2,Included in per diem,232.75,Included in ER Case rate,232.75,232.75, 240.10 ,220.5
3253856WWM,EAP,Custom 3253856WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Rumi Tip 5.1x6#uml516,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
3253853WWM,EAP,Custom 3253853WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Rumi Tip 6.7x10#umg670,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
3253855WWM,EAP,Custom 3253855WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Rumi Tip 6.7x6#umw676,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
3253854WWM,EAP,Custom 3253854WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Rumi Tip 6.7x8#umb678,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
3253646WWM,EAP,Custom 3253646WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Scorp Needle #ar13991n,1,357, 339.15 ,349.86, 339.15 , 346.29 , 339.15 ,Current Medicare Rates,346.29,342.72,Included in per diem,339.15,Included in ER Case rate,339.15,339.15, 349.86 ,321.3
3253999WWM,EAP,Custom 3253999WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 2.4x12#02-210-11,1,403, 382.85 ,394.94, 382.85 , 390.91 , 382.85 ,Current Medicare Rates,390.91,386.88,Included in per diem,382.85,Included in ER Case rate,382.85,382.85, 394.94 ,362.7
3254000WWM,EAP,Custom 3254000WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 2.4x20#02-210-12,1,403, 382.85 ,394.94, 382.85 , 390.91 , 382.85 ,Current Medicare Rates,390.91,386.88,Included in per diem,382.85,Included in ER Case rate,382.85,382.85, 394.94 ,362.7
3254001WWM,EAP,Custom 3254001WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 2.4x22#02-210-12,1,403, 382.85 ,394.94, 382.85 , 390.91 , 382.85 ,Current Medicare Rates,390.91,386.88,Included in per diem,382.85,Included in ER Case rate,382.85,382.85, 394.94 ,362.7
3254039WWM,EAP,Custom 3254039WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 2.7x10#dc2825010,1,432, 410.40 ,423.36, 410.40 , 419.04 , 410.40 ,Current Medicare Rates,419.04,414.72,Included in per diem,410.4,Included in ER Case rate,410.4,410.4, 423.36 ,388.8
3254040WWM,EAP,Custom 3254040WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 2.7x12#dc2825012,1,432, 410.40 ,423.36, 410.40 , 419.04 , 410.40 ,Current Medicare Rates,419.04,414.72,Included in per diem,410.4,Included in ER Case rate,410.4,410.4, 423.36 ,388.8
3254041WWM,EAP,Custom 3254041WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 2.7x14#dc2825014,1,432, 410.40 ,423.36, 410.40 , 419.04 , 410.40 ,Current Medicare Rates,419.04,414.72,Included in per diem,410.4,Included in ER Case rate,410.4,410.4, 423.36 ,388.8
3254038WWM,EAP,Custom 3254038WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 2.7x8#dc2825008,1,432, 410.40 ,423.36, 410.40 , 419.04 , 410.40 ,Current Medicare Rates,419.04,414.72,Included in per diem,410.4,Included in ER Case rate,410.4,410.4, 423.36 ,388.8
3254052WWM,EAP,Custom 3254052WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 3.5x10#ar8835-10,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253949WWM,EAP,Custom 3253949WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 3.5x12#cs12000,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
3253950WWM,EAP,Custom 3253950WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw 3.5x14 #cs14000,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
3254007WWM,EAP,Custom 3254007WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Bone 34mm#at2-s3,1,1001, 950.95 ,980.98, 950.95 , 970.97 , 950.95 ,Current Medicare Rates,970.97,960.96,Included in per diem,950.95,Included in ER Case rate,950.95,950.95, 980.98 ,900.9
3254008WWM,EAP,Custom 3254008WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Bone 40mm#am-004,1,908, 862.60 ,889.84, 862.60 , 880.76 , 862.60 ,Current Medicare Rates,880.76,871.68,Included in per diem,862.6,Included in ER Case rate,862.6,862.6, 889.84 ,817.2
3254009WWM,EAP,Custom 3254009WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Bone 45mm#am-004,1,908, 862.60 ,889.84, 862.60 , 880.76 , 862.60 ,Current Medicare Rates,880.76,871.68,Included in per diem,862.6,Included in ER Case rate,862.6,862.6, 889.84 ,817.2
3253906WWM,EAP,Custom 3253906WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Cann 4x50#ar-884,1,441, 418.95 ,432.18, 418.95 , 427.77 , 418.95 ,Current Medicare Rates,427.77,423.36,Included in per diem,418.95,Included in ER Case rate,418.95,418.95, 432.18 ,396.9
3254036WWM,EAP,Custom 3254036WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Cann 4x55#ar8840,1,549, 521.55 ,538.02, 521.55 , 532.53 , 521.55 ,Current Medicare Rates,532.53,527.04,Included in per diem,521.55,Included in ER Case rate,521.55,521.55, 538.02 ,494.1
3253996WWM,EAP,Custom 3253996WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Cann 4x60#ar-884,1,549, 521.55 ,538.02, 521.55 , 532.53 , 521.55 ,Current Medicare Rates,532.53,527.04,Included in per diem,521.55,Included in ER Case rate,521.55,521.55, 538.02 ,494.1
3254002WWM,EAP,Custom 3254002WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Cort 2.7x12#202,1,171, 162.45 ,167.58, 162.45 , 165.87 , 162.45 ,Current Medicare Rates,165.87,164.16,Included in per diem,162.45,Included in ER Case rate,162.45,162.45, 167.58 ,153.9
3253991WWM,EAP,Custom 3253991WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Cort 3.5x12#ar-8,1,180, 171.00 ,176.4, 171.00 , 174.60 , 171.00 ,Current Medicare Rates,174.6,172.8,Included in per diem,171,Included in ER Case rate,171,171, 176.40 ,162
3253995WWM,EAP,Custom 3253995WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Cort 3.5x14#ar-8,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253905WWM,EAP,Custom 3253905WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Cort 3.5x18#ar-8,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3254053WWM,EAP,Custom 3254053WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Loc 3.5x10#ar883,1,403, 382.85 ,394.94, 382.85 , 390.91 , 382.85 ,Current Medicare Rates,390.91,386.88,Included in per diem,382.85,Included in ER Case rate,382.85,382.85, 394.94 ,362.7
3253903WWM,EAP,Custom 3253903WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Loc 3.5x12#ar-88,1,403, 382.85 ,394.94, 382.85 , 390.91 , 382.85 ,Current Medicare Rates,390.91,386.88,Included in per diem,382.85,Included in ER Case rate,382.85,382.85, 394.94 ,362.7
3253904WWM,EAP,Custom 3253904WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Loc 3.5x14#ar-88,1,324, 307.80 ,317.52, 307.80 , 314.28 , 307.80 ,Current Medicare Rates,314.28,311.04,Included in per diem,307.8,Included in ER Case rate,307.8,307.8, 317.52 ,291.6
3253977WWM,EAP,Custom 3253977WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock #ar8827l-14,1,383, 363.85 ,375.34, 363.85 , 371.51 , 363.85 ,Current Medicare Rates,371.51,367.68,Included in per diem,363.85,Included in ER Case rate,363.85,363.85, 375.34 ,344.7
3253992WWM,EAP,Custom 3253992WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock 3.5x16#ar-8,1,403, 382.85 ,394.94, 382.85 , 390.91 , 382.85 ,Current Medicare Rates,390.91,386.88,Included in per diem,382.85,Included in ER Case rate,382.85,382.85, 394.94 ,362.7
3254035WWM,EAP,Custom 3254035WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock#ar-8827l-10,1,383, 363.85 ,375.34, 363.85 , 371.51 , 363.85 ,Current Medicare Rates,371.51,367.68,Included in per diem,363.85,Included in ER Case rate,363.85,363.85, 375.34 ,344.7
3253933WWM,EAP,Custom 3253933WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock#ar-8827l-12,1,306, 290.70 ,299.88, 290.70 , 296.82 , 290.70 ,Current Medicare Rates,296.82,293.76,Included in per diem,290.7,Included in ER Case rate,290.7,290.7, 299.88 ,275.4
3253934WWM,EAP,Custom 3253934WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock#ar-8827l-16,1,306, 290.70 ,299.88, 290.70 , 296.82 , 290.70 ,Current Medicare Rates,296.82,293.76,Included in per diem,290.7,Included in ER Case rate,290.7,290.7, 299.88 ,275.4
3253935WWM,EAP,Custom 3253935WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock#ar-8827l-18,1,306, 290.70 ,299.88, 290.70 , 296.82 , 290.70 ,Current Medicare Rates,296.82,293.76,Included in per diem,290.7,Included in ER Case rate,290.7,290.7, 299.88 ,275.4
3253936WWM,EAP,Custom 3253936WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock#ar-8835l-16,1,324, 307.80 ,317.52, 307.80 , 314.28 , 307.80 ,Current Medicare Rates,314.28,311.04,Included in per diem,307.8,Included in ER Case rate,307.8,307.8, 317.52 ,291.6
3253937WWM,EAP,Custom 3253937WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Lock#ar-8835l-20,1,324, 307.80 ,317.52, 307.80 , 314.28 , 307.80 ,Current Medicare Rates,314.28,311.04,Included in per diem,307.8,Included in ER Case rate,307.8,307.8, 317.52 ,291.6
3253994WWM,EAP,Custom 3253994WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Long 4x60#ar8840,1,180, 171.00 ,176.4, 171.00 , 174.60 , 171.00 ,Current Medicare Rates,174.6,172.8,Included in per diem,171,Included in ER Case rate,171,171, 176.40 ,162
3254042WWM,EAP,Custom 3254042WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Nl 2.7x10#dc2825,1,217, 206.15 ,212.66, 206.15 , 210.49 , 206.15 ,Current Medicare Rates,210.49,208.32,Included in per diem,206.15,Included in ER Case rate,206.15,206.15, 212.66 ,195.3
3254026WWM,EAP,Custom 3254026WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Teno #ar-1540ps,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,Included in per diem,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
3254027WWM,EAP,Custom 3254027WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Teno #ar-1547ps,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,Included in per diem,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
3254028WWM,EAP,Custom 3254028WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Teno #ar-1555ps,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,Included in per diem,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
3253919WWM,EAP,Custom 3253919WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Teno #ar-1580ps,1,837, 795.15 ,820.26, 795.15 , 811.89 , 795.15 ,Current Medicare Rates,811.89,803.52,Included in per diem,795.15,Included in ER Case rate,795.15,795.15, 820.26 ,753.3
3254011WWM,EAP,Custom 3254011WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Teno #ar-1590ps,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,Included in per diem,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
3254005WWM,EAP,Custom 3254005WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Screw Tenodesis 7x23,1,782, 742.90 ,766.36, 742.90 , 758.54 , 742.90 ,Current Medicare Rates,758.54,750.72,Included in per diem,742.9,Included in ER Case rate,742.9,742.9, 766.36 ,703.8
3254068WWM,EAP,Custom 3254068WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Secure Strap #strap25,1,1045, 992.75 ,1024.1, 992.75 ," 1,013.65 ", 992.75 ,Current Medicare Rates,1013.65,1003.2,Included in per diem,992.75,Included in ER Case rate,992.75,992.75," 1,024.10 ",940.5
3253524WWM,EAP,Custom 3253524WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Shoulder Stab Kit,1,236, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
3252892WWM,EAP,Custom 3252892WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Sigmoid Suct #0033050,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
3250583WWM,EAP,Custom 3250583WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Snare Rotate#m00561821,1,186, 176.70 ,182.28, 176.70 , 180.42 , 176.70 ,Current Medicare Rates,180.42,178.56,Included in per diem,176.7,Included in ER Case rate,176.7,176.7, 182.28 ,167.4
3253755WWM,EAP,Custom 3253755WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Spot Dye #gis-44,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
3253143WWM,EAP,Custom 3253143WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Curv #cs40b,1,953, 905.35 ,933.94, 905.35 , 924.41 , 905.35 ,Current Medicare Rates,924.41,914.88,Included in per diem,905.35,Included in ER Case rate,905.35,905.35, 933.94 ,857.7
3253144WWM,EAP,Custom 3253144WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Curv Rel#cr40b,1,494, 469.30 ,484.12, 469.30 , 479.18 , 469.30 ,Current Medicare Rates,479.18,474.24,Included in per diem,469.3,Included in ER Case rate,469.3,469.3, 484.12 ,444.6
3252534WWM,EAP,Custom 3252534WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Lnr Re60 Xr60b,1,251, 238.45 ,245.98, 238.45 , 243.47 , 238.45 ,Current Medicare Rates,243.47,240.96,Included in per diem,238.45,Included in ER Case rate,238.45,238.45, 245.98 ,225.9
3252532WWM,EAP,Custom 3252532WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Lnr Re60#tx60b,1,275, 261.25 ,269.5, 261.25 , 266.75 , 261.25 ,Current Medicare Rates,266.75,264,Included in per diem,261.25,Included in ER Case rate,261.25,261.25, 269.50 ,247.5
3253721WWM,EAP,Custom 3253721WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Pph #pph03,1,820, 779.00 ,803.6, 779.00 , 795.40 , 779.00 ,Current Medicare Rates,795.4,787.2,Included in per diem,779,Included in ER Case rate,779,779, 803.60 ,738
3253997WWM,EAP,Custom 3253997WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Prox #ax55b,1,468, 444.60 ,458.64, 444.60 , 453.96 , 444.60 ,Current Medicare Rates,453.96,449.28,Included in per diem,444.6,Included in ER Case rate,444.6,444.6, 458.64 ,421.2
3252909WWM,EAP,Custom 3252909WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Prox #prw35,1,128, 121.60 ,125.44, 121.60 , 124.16 , 121.60 ,Current Medicare Rates,124.16,122.88,Included in per diem,121.6,Included in ER Case rate,121.6,121.6, 125.44 ,115.2
3252910WWM,EAP,Custom 3252910WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Prox Prr35,1,128, 121.60 ,125.44, 121.60 , 124.16 , 121.60 ,Current Medicare Rates,124.16,122.88,Included in per diem,121.6,Included in ER Case rate,121.6,121.6, 125.44 ,115.2
3252912WWM,EAP,Custom 3252912WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Prox+md #pmr35,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
3252712WWM,EAP,Custom 3252712WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Pwr Lds#092001,1,719, 683.05 ,704.62, 683.05 , 697.43 , 683.05 ,Current Medicare Rates,697.43,690.24,Included in per diem,683.05,Included in ER Case rate,683.05,683.05, 704.62 ,647.1
3254069WWM,EAP,Custom 3254069WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Stapler Rld Hernia # 174007,1,326, 309.70 ,319.48, 309.70 , 316.22 , 309.70 ,Current Medicare Rates,316.22,312.96,Included in per diem,309.7,Included in ER Case rate,309.7,309.7, 319.48 ,293.4
3253679WWM,EAP,Custom 3253679WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Step Drill 2.4#ar1250l,1,255, 242.25 ,249.9, 242.25 , 247.35 , 242.25 ,Current Medicare Rates,247.35,244.8,Included in per diem,242.25,Included in ER Case rate,242.25,242.25, 249.90 ,229.5
3253534WWM,EAP,Custom 3253534WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Strk Aggres Wid Blade,1,154, 146.30 ,150.92, 146.30 , 149.38 , 146.30 ,Current Medicare Rates,149.38,147.84,Included in per diem,146.3,Included in ER Case rate,146.3,146.3, 150.92 ,138.6
3253535WWM,EAP,Custom 3253535WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Strk Minor Mod Prod,1,273, 259.35 ,267.54, 259.35 , 264.81 , 259.35 ,Current Medicare Rates,264.81,262.08,Included in per diem,259.35,Included in ER Case rate,259.35,259.35, 267.54 ,245.7
3253536WWM,EAP,Custom 3253536WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Strk Narrow Blade,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
3253898WWM,EAP,Custom 3253898WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Anchor Corkscrew#ar,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,Included in per diem,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
3253899WWM,EAP,Custom 3253899WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Anchor Peek 4.75#ar,1,907, 861.65 ,888.86, 861.65 , 879.79 , 861.65 ,Current Medicare Rates,879.79,870.72,Included in per diem,861.65,Included in ER Case rate,861.65,861.65, 888.86 ,816.3
3253897WWM,EAP,Custom 3253897WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Anchor Peek 4.75#ar,1,969, 920.55 ,949.62, 920.55 , 939.93 , 920.55 ,Current Medicare Rates,939.93,930.24,Included in per diem,920.55,Included in ER Case rate,920.55,920.55, 949.62 ,872.1
3253896WWM,EAP,Custom 3253896WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Anchor Peek 5.5#ar-,1,969, 920.55 ,949.62, 920.55 , 939.93 , 920.55 ,Current Medicare Rates,939.93,930.24,Included in per diem,920.55,Included in ER Case rate,920.55,920.55, 949.62 ,872.1
3253683WWM,EAP,Custom 3253683WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Fiberlink #2 #ar723,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253681WWM,EAP,Custom 3253681WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Lasso 25 Lt# Ar4068,1,357, 339.15 ,349.86, 339.15 , 346.29 , 339.15 ,Current Medicare Rates,346.29,342.72,Included in per diem,339.15,Included in ER Case rate,339.15,339.15, 349.86 ,321.3
3253589WWM,EAP,Custom 3253589WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Lasso 25 Rt,1,357, 339.15 ,349.86, 339.15 , 346.29 , 339.15 ,Current Medicare Rates,346.29,342.72,Included in per diem,339.15,Included in ER Case rate,339.15,339.15, 349.86 ,321.3
3253682WWM,EAP,Custom 3253682WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Lasso Cres# Ar4068c,1,357, 339.15 ,349.86, 339.15 , 346.29 , 339.15 ,Current Medicare Rates,346.29,342.72,Included in per diem,339.15,Included in ER Case rate,339.15,339.15, 349.86 ,321.3
3253850WWM,EAP,Custom 3253850WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Su Vicryl 0 #d9716,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,Included in per diem,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
3252706WWM,EAP,Custom 3252706WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Suct Coag 10fr#e2505,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
3252559WWM,EAP,Custom 3252559WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Suct Irrig  #250070520,1,207, 196.65 ,202.86, 196.65 , 200.79 , 196.65 ,Current Medicare Rates,200.79,198.72,Included in per diem,196.65,Included in ER Case rate,196.65,196.65, 202.86 ,186.3
3252787WWM,EAP,Custom 3252787WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Suct Poole Tip#0035040,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
3252517WWM,EAP,Custom 3252517WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Suct Set/vigrd#smp001s,1,97, 92.15 ,95.06, 92.15 , 94.09 , 92.15 ,Current Medicare Rates,94.09,93.12,Included in per diem,92.15,Included in ER Case rate,92.15,92.15, 95.06 ,87.3
3252536WWM,EAP,Custom 3252536WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Surgicell Abs/hem#1963,1,413, 392.35 ,404.74, 392.35 , 400.61 , 392.35 ,Current Medicare Rates,400.61,396.48,Included in per diem,392.35,Included in ER Case rate,392.35,392.35, 404.74 ,371.7
3253539WWM,EAP,Custom 3253539WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Suture Lasso 90 Str,1,357, 339.15 ,349.86, 339.15 , 346.29 , 339.15 ,Current Medicare Rates,346.29,342.72,Included in per diem,339.15,Included in ER Case rate,339.15,339.15, 349.86 ,321.3
3253945WWM,EAP,Custom 3253945WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Swivelock #ar-1662bc-8,1,893, 848.35 ,875.14, 848.35 , 866.21 , 848.35 ,Current Medicare Rates,866.21,857.28,Included in per diem,848.35,Included in ER Case rate,848.35,848.35, 875.14 ,803.7
3253974WWM,EAP,Custom 3253974WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Swivelock #ar1662psl-7,1,1041, 988.95 ,1020.18, 988.95 ," 1,009.77 ", 988.95 ,Current Medicare Rates,1009.77,999.36,Included in per diem,988.95,Included in ER Case rate,988.95,988.95," 1,020.18 ",936.9
3253939WWM,EAP,Custom 3253939WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Synergy Combo#snghk2,1,763, 724.85 ,747.74, 724.85 , 740.11 , 724.85 ,Current Medicare Rates,740.11,732.48,Included in per diem,724.85,Included in ER Case rate,724.85,724.85, 747.74 ,686.7
3254075WWM,EAP,Custom 3254075WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tape Labral #ar-7276,1,250, 237.50 ,245, 237.50 , 242.50 , 237.50 ,Current Medicare Rates,242.5,240,Included in per diem,237.5,Included in ER Case rate,237.5,237.5, 245.00 ,225
3254046WWM,EAP,Custom 3254046WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tigerstick #ar-7209t,1,253, 240.35 ,247.94, 240.35 , 245.41 , 240.35 ,Current Medicare Rates,245.41,242.88,Included in per diem,240.35,Included in ER Case rate,240.35,240.35, 247.94 ,227.7
3254034WWM,EAP,Custom 3254034WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tight Rope #ar-8926ss,1,"2,325.00"," 2,208.75 ",2278.5," 2,208.75 "," 2,255.25 "," 2,208.75 ",Current Medicare Rates,2255.25,2232,Included in per diem,2208.75,Included in ER Case rate,2208.75,2208.75," 2,278.50 ",2092.5
3254127WWM,EAP,Custom 3254127WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tightrope Acl Closed Eye #ar1595tc,1,380, 361.00 ,372.4, 361.00 , 368.60 , 361.00 ,Current Medicare Rates,368.6,364.8,Included in per diem,361,Included in ER Case rate,361,361, 372.40 ,342
3254048WWM,EAP,Custom 3254048WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tightrope Acl#ar-1588r,1,1002, 951.90 ,981.96, 951.90 , 971.94 , 951.90 ,Current Medicare Rates,971.94,961.92,Included in per diem,951.9,Included in ER Case rate,951.9,951.9, 981.96 ,901.8
3254120WWM,EAP,Custom 3254120WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tightrope Rt W/ Su,1,899, 854.05 ,881.02, 854.05 , 872.03 , 854.05 ,Current Medicare Rates,872.03,863.04,Included in per diem,854.05,Included in ER Case rate,854.05,854.05, 881.02 ,809.1
3254118WWM,EAP,Custom 3254118WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tightrope Rt W/ Su #ar-1588rt-j,1,899, 854.05 ,881.02, 854.05 , 872.03 , 854.05 ,Current Medicare Rates,872.03,863.04,Included in per diem,854.05,Included in ER Case rate,854.05,854.05, 881.02 ,809.1
3253902WWM,EAP,Custom 3253902WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tightrope#ar-8921cds,1,"1,356.00"," 1,288.20 ",1328.88," 1,288.20 "," 1,315.32 "," 1,288.20 ",Current Medicare Rates,1315.32,1301.76,Included in per diem,1288.2,Included in ER Case rate,1288.2,1288.2," 1,328.88 ",1220.4
3254049WWM,EAP,Custom 3254049WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tissue #43917000,1,"3,730.00"," 3,543.50 ",3655.4," 3,543.50 "," 3,618.10 "," 3,543.50 ",Current Medicare Rates,3618.1,3580.8,Included in per diem,3543.5,Included in ER Case rate,3543.5,3543.5," 3,655.40 ",3357
3253567WWM,EAP,Custom 3253567WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Transtibial Acl,1,531, 504.45 ,520.38, 504.45 , 515.07 , 504.45 ,Current Medicare Rates,515.07,509.76,Included in per diem,504.45,Included in ER Case rate,504.45,504.45, 520.38 ,477.9
3253926WWM,EAP,Custom 3253926WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar #2b5lt,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3253840WWM,EAP,Custom 3253840WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar 12 Mm# B12srt,1,232, 220.40 ,227.36, 220.40 , 225.04 , 220.40 ,Current Medicare Rates,225.04,222.72,Included in per diem,220.4,Included in ER Case rate,220.4,220.4, 227.36 ,208.8
3253250WWM,EAP,Custom 3253250WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar 12mm #b12lt,1,232, 220.40 ,227.36, 220.40 , 225.04 , 220.40 ,Current Medicare Rates,225.04,222.72,Included in per diem,220.4,Included in ER Case rate,220.4,220.4, 227.36 ,208.8
3253251WWM,EAP,Custom 3253251WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar 12mm#cb12lt,1,179, 170.05 ,175.42, 170.05 , 173.63 , 170.05 ,Current Medicare Rates,173.63,171.84,Included in per diem,170.05,Included in ER Case rate,170.05,170.05, 175.42 ,161.1
3253841WWM,EAP,Custom 3253841WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar 5 Mm #b5st,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3253248WWM,EAP,Custom 3253248WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar 5mm #b5lt,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
3253249WWM,EAP,Custom 3253249WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar 5mm#cb5lt,1,137, 130.15 ,134.26, 130.15 , 132.89 , 130.15 ,Current Medicare Rates,132.89,131.52,Included in per diem,130.15,Included in ER Case rate,130.15,130.15, 134.26 ,123.3
3253927WWM,EAP,Custom 3253927WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar Sleeve #2cb5lt,1,137, 130.15 ,134.26, 130.15 , 132.89 , 130.15 ,Current Medicare Rates,132.89,131.52,Included in per diem,130.15,Included in ER Case rate,130.15,130.15, 134.26 ,123.3
3253400WWM,EAP,Custom 3253400WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar Xl 12mm#b12xt,1,209, 198.55 ,204.82, 198.55 , 202.73 , 198.55 ,Current Medicare Rates,202.73,200.64,Included in per diem,198.55,Included in ER Case rate,198.55,198.55, 204.82 ,188.1
3253399WWM,EAP,Custom 3253399WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Trocar Xl 5mm#b5xt,1,236, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
3253915WWM,EAP,Custom 3253915WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tubing Patient#ar-6421,1,139, 132.05 ,136.22, 132.05 , 134.83 , 132.05 ,Current Medicare Rates,134.83,133.44,Included in per diem,132.05,Included in ER Case rate,132.05,132.05, 136.22 ,125.1
3253918WWM,EAP,Custom 3253918WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tubing Pump #ar-6411,1,233, 221.35 ,228.34, 221.35 , 226.01 , 221.35 ,Current Medicare Rates,226.01,223.68,Included in per diem,221.35,Included in ER Case rate,221.35,221.35, 228.34 ,209.7
3253941WWM,EAP,Custom 3253941WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Tubing Pump#ar-6410,1,233, 221.35 ,228.34, 221.35 , 226.01 , 221.35 ,Current Medicare Rates,226.01,223.68,Included in per diem,221.35,Included in ER Case rate,221.35,221.35, 228.34 ,209.7
3252972WWM,EAP,Custom 3252972WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Uterine Asp Tube #151,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
3253627WWM,EAP,Custom 3253627WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Vilex Guidewire,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
3253786WWM,EAP,Custom 3253786WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Waffle Table Pad# 1100,1,239, 227.05 ,234.22, 227.05 , 231.83 , 227.05 ,Current Medicare Rates,231.83,229.44,Included in per diem,227.05,Included in ER Case rate,227.05,227.05, 234.22 ,215.1
3254020WWM,EAP,Custom 3254020WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Wire Guide #ws-2009st,1,119, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3254021WWM,EAP,Custom 3254021WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Wire Guide #wt-1606stt,1,180.6, 171.57 ,176.99, 171.57 , 175.18 , 171.57 ,Current Medicare Rates,175.18,173.38,Included in per diem,171.57,Included in ER Case rate,171.57,171.57, 176.99 ,162.54
3254204WWM,EAP,Custom 3254204WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Or Zip Pencil #252510ec,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253768WWM,EAP,Custom 3253768WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ostomy Deodorant #78500,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
3253767WWM,EAP,Custom 3253767WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ostomy Paste #79300,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
4153766WWM,EAP,Custom 4153766WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ostomy Pouch #18373a,1,7, 6.65 ,6.86, 6.65 , 6.79 , 6.65 ,Current Medicare Rates,6.79,6.72,Included in per diem,6.65,Included in ER Case rate,6.65,6.65, 6.86 ,6.3
4153769WWM,EAP,Custom 4153769WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ostomy Pouch #18403,1,17, 16.15 ,16.66, 16.15 , 16.49 , 16.15 ,Current Medicare Rates,16.49,16.32,Included in per diem,16.15,Included in ER Case rate,16.15,16.15, 16.66 ,15.3
27010162,EAP,Custom 27010162,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ostomy Pouch #3803,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3254030WWM,EAP,Custom 3254030WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ostomy Powder #hl7906a,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
3253108WWM,EAP,Custom 3253108WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ostomy Wafer #3738,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
3253817WWM,EAP,Custom 3253817WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Oxygen Per Day,1,246, 233.70 ,241.08, 233.70 , 238.62 , 233.70 ,Current Medicare Rates,238.62,236.16,Included in per diem,233.7,Included in ER Case rate,233.7,233.7, 241.08 ,221.4
3253139WWM,EAP,Custom 3253139WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Peep Valve #199002020,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
3253836WWM,EAP,Custom 3253836WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Philips Et Co2 Ped#m2524a,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
3253834WWM,EAP,Custom 3253834WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Philips Et Co2 Vent #m192,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
3250277WWM,EAP,Custom 3250277WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pleur-evac #a7000,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
3253774WWM,EAP,Custom 3253774WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Cold Pack #nc70532,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
3253756WWM,EAP,Custom 3253756WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Ez Reach Light#nc28522,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3253474WWM,EAP,Custom 3253474WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Ez Reach W/ Lock,1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
3253878WWM,EAP,Custom 3253878WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Foot Up Lg #nc81022-2,1,240, 228.00 ,235.2, 228.00 , 232.80 , 228.00 ,Current Medicare Rates,232.8,230.4,Included in per diem,228,Included in ER Case rate,228,228, 235.20 ,216
3253879WWM,EAP,Custom 3253879WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Foot Up Xlg #nc81022-3,1,240, 228.00 ,235.2, 228.00 , 232.80 , 228.00 ,Current Medicare Rates,232.8,230.4,Included in per diem,228,Included in ER Case rate,228,228, 235.20 ,216
3253334WWM,EAP,Custom 3253334WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Heel Lift Med#nc57187-,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,Included in per diem,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
3253333WWM,EAP,Custom 3253333WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Heel Lift Sm #nc57187-,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3253727WWM,EAP,Custom 3253727WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Overdor Pull Ext#nc520,1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,Included in per diem,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
3253518WWM,EAP,Custom 3253518WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Overdor Tract#nc92610,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
3253866WWM,EAP,Custom 3253866WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Pt Shoehorn 24"" #nc65632",1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3253757WWM,EAP,Custom 3253757WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Sock Aid #nc28600,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
3253469WWM,EAP,Custom 3253469WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Sock Aid 1 #nc26600,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253406WWM,EAP,Custom 3253406WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Splint L/lg #nc81020-5,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,Included in per diem,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
3253402WWM,EAP,Custom 3253402WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Pt Splint L/sm #nc81020-1,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,Included in per diem,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
3254199WWM,EAP,Custom 3254199WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Quikclotzfold #1095413,1,225, 213.75 ,220.5, 213.75 , 218.25 , 213.75 ,Current Medicare Rates,218.25,216,Included in per diem,213.75,Included in ER Case rate,213.75,213.75, 220.50 ,202.5
3250728WWM,EAP,Custom 3250728WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rapid Rhino 5.5 Ant #rr550,1,153, 145.35 ,149.94, 145.35 , 148.41 , 145.35 ,Current Medicare Rates,148.41,146.88,Included in per diem,145.35,Included in ER Case rate,145.35,145.35, 149.94 ,137.7
3250729WWM,EAP,Custom 3250729WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rapid Rhino 7.5 A/p#rr750,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
3252806WWM,EAP,Custom 3252806WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Acapella #26-21-1530,1,190, 180.50 ,186.2, 180.50 , 184.30 , 180.50 ,Current Medicare Rates,184.3,182.4,Included in per diem,180.5,Included in ER Case rate,180.5,180.5, 186.20 ,171
3253278WWM,EAP,Custom 3253278WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Acapella Lo #26-21-101,1,190, 180.50 ,186.2, 180.50 , 184.30 , 180.50 ,Current Medicare Rates,184.3,182.4,Included in per diem,180.5,Included in ER Case rate,180.5,180.5, 186.20 ,171
3252869WWM,EAP,Custom 3252869WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Aerochamber #79710,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
3252980WWM,EAP,Custom 3252980WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Co2 Detect #easy Capii,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3252863WWM,EAP,Custom 3252863WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt E-z Wraps Ear Pro#1016,1,8, 7.60 ,7.84, 7.60 , 7.76 , 7.60 ,Current Medicare Rates,7.76,7.68,Included in per diem,7.6,Included in ER Case rate,7.6,7.6, 7.84 ,7.2
3254110WWM,EAP,Custom 3254110WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Flutter Valve #58-62510,1,160, 152.00 ,156.8, 152.00 , 155.20 , 152.00 ,Current Medicare Rates,155.2,153.6,Included in per diem,152,Included in ER Case rate,152,152, 156.80 ,144
3252894WWM,EAP,Custom 3252894WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Incentive Spirometer,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3253293WWM,EAP,Custom 3253293WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Nebulizer Lg Vol,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
3253127WWM,EAP,Custom 3253127WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Neo Aerochamb Mask,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
3253137WWM,EAP,Custom 3253137WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Oximizer Cannula#p-224,1,165, 156.75 ,161.7, 156.75 , 160.05 , 156.75 ,Current Medicare Rates,160.05,158.4,Included in per diem,156.75,Included in ER Case rate,156.75,156.75, 161.70 ,148.5
3252956WWM,EAP,Custom 3252956WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Peak Flow Meter #96510,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
3253126WWM,EAP,Custom 3253126WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Ped Aerochamb Mask,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
3250802WWM,EAP,Custom 3250802WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Sensor Infant #i20,1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
3253759WWM,EAP,Custom 3253759WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Rt Sensor Sp02 #m1133a,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
3254076WWM,EAP,Custom 3254076WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Shoulder Susp #dynjshoulder,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
3257145WWM,EAP,Custom 3257145WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Sitz Bath,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3253987WWM,EAP,Custom 3253987WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Skin Dermabond #dnx12,1,121, 114.95 ,118.58, 114.95 , 117.37 , 114.95 ,Current Medicare Rates,117.37,116.16,Included in per diem,114.95,Included in ER Case rate,114.95,114.95, 118.58 ,108.9
3252696WWM,EAP,Custom 3252696WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Sling Arm Ped #104sm,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3250305WWM,EAP,Custom 3250305WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Sling Arm W/loop #104j-l,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3252693WWM,EAP,Custom 3252693WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Sling Arm W/loop M 105j-m,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3252694WWM,EAP,Custom 3252694WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Sling Arm W/loop S 105j-s,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3252691WWM,EAP,Custom 3252691WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Sling Arm W/loop Xl105j-x,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3250689WWM,EAP,Custom 3250689WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Specimen Trap 10fr#smt910,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3250309WWM,EAP,Custom 3250309WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Specimen Trap 40cc,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3252571WWM,EAP,Custom 3252571WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Specimen Trap 8fr #smt808,1,56, 53.20 ,54.88, 53.20 , 54.32 , 53.20 ,Current Medicare Rates,54.32,53.76,Included in per diem,53.2,Included in ER Case rate,53.2,53.2, 54.88 ,50.4
3250805WWM,EAP,Custom 3250805WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Ankle Gel#79-97865,1,88, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
3250339WWM,EAP,Custom 3250339WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Fgr 4pro S #190363,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
3253656WWM,EAP,Custom 3253656WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Splint Knee 16"" #d1160917",1,121, 114.95 ,118.58, 114.95 , 117.37 , 114.95 ,Current Medicare Rates,117.37,116.16,Included in per diem,114.95,Included in ER Case rate,114.95,114.95, 118.58 ,108.9
3253874WWM,EAP,Custom 3253874WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Splint Knee 19"" #d1190917",1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,Included in per diem,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
3252675WWM,EAP,Custom 3252675WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Thumb Lg/l #3070,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,Included in per diem,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
3252676WWM,EAP,Custom 3252676WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Thumb Lg/r #3170,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,Included in per diem,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
3252679WWM,EAP,Custom 3252679WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Thumb Med /l #3050,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
3252680WWM,EAP,Custom 3252680WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Thumb Med/r #3150,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,Included in per diem,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
3252678WWM,EAP,Custom 3252678WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Thumb Sm/l #3030,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
3252674WWM,EAP,Custom 3252674WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Thumb Xl/l #3080,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
3258000WWM,EAP,Custom 3258000WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint Thumb Xl/r #3180,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
3250331WWM,EAP,Custom 3250331WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f L/l #210125,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250332WWM,EAP,Custom 3250332WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f Lg/r #210115,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250329WWM,EAP,Custom 3250329WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f M/l #tx990408,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250330WWM,EAP,Custom 3250330WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f M/r #217075,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250327WWM,EAP,Custom 3250327WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f S/l #,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250328WWM,EAP,Custom 3250328WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f S/r #2101-13,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250334WWM,EAP,Custom 3250334WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f Xl/l#210126,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250333WWM,EAP,Custom 3250333WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f Xl/r #210116,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3250326WWM,EAP,Custom 3250326WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splint W/f Xs/l #210122,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
3253149WWM,EAP,Custom 3253149WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splnt Rib Blt Lg#13760307,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
3253148WWM,EAP,Custom 3253148WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splnt Rib Blt Md#13760306,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
3253147WWM,EAP,Custom 3253147WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splnt Rib Blt Sm#13760305,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
3253150WWM,EAP,Custom 3253150WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Splnt Rib Blt Xl#13760308,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
3254074WWM,EAP,Custom 3254074WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Stapler Endo Hernia,1,768, 729.60 ,752.64, 729.60 , 744.96 , 729.60 ,Current Medicare Rates,744.96,737.28,Included in per diem,729.6,Included in ER Case rate,729.6,729.6, 752.64 ,691.2
3252842WWM,EAP,Custom 3252842WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Stomahesive #183910,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
3250539WWM,EAP,Custom 3250539WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Straps Leg Bag #162310,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
3253808WWM,EAP,Custom 3253808WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Su Gortex 0 #on07a,1,119, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3252548WWM,EAP,Custom 3252548WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Su Vicryl Endo Loop#ej10g,1,168, 159.60 ,164.64, 159.60 , 162.96 , 159.60 ,Current Medicare Rates,162.96,161.28,Included in per diem,159.6,Included in ER Case rate,159.6,159.6, 164.64 ,151.2
3253380WWM,EAP,Custom 3253380WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Suct Irrigator Pulsed,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253395WWM,EAP,Custom 3253395WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Suct Tube Attach #9785,1,18, 17.10 ,17.64, 17.10 , 17.46 , 17.10 ,Current Medicare Rates,17.46,17.28,Included in per diem,17.1,Included in ER Case rate,17.1,17.1, 17.64 ,16.2
3252633WWM,EAP,Custom 3252633WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Suct Tube Conn 10'#036290,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
3253258WWM,EAP,Custom 3253258WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Tape Medipore 2"" #2962",1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3250188WWM,EAP,Custom 3250188WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Tape Medipore 3"" #2963",1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3253259WWM,EAP,Custom 3253259WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Tape Medipore 4"" #2964",1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,Included in per diem,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
3253076WWM,EAP,Custom 3253076WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,"Hc Tape Medipore 6""",1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3250773WWM,EAP,Custom 3250773WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee L/long #7594,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3252828WWM,EAP,Custom 3252828WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee L/reg #7203,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,Included in per diem,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
3252827WWM,EAP,Custom 3252827WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee M/long #7480,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3252826WWM,EAP,Custom 3252826WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee M/reg #7115,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
3254188WWM,EAP,Custom 3254188WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee Md Long Mds160648h,1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
3254187WWM,EAP,Custom 3254187WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee Sm Long Mds160628h,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
3252824WWM,EAP,Custom 3252824WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee Sm/reg #7071,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3252831WWM,EAP,Custom 3252831WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee Xl/long#7802,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252830WWM,EAP,Custom 3252830WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Knee Xl/reg#7604,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3250442WWM,EAP,Custom 3250442WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Large/short #3634,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3252569WWM,EAP,Custom 3252569WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Lrg/lng #3856,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3252570WWM,EAP,Custom 3252570WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Lrg/reg #3728,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3252567WWM,EAP,Custom 3252567WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Med/lng #3549,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,Included in per diem,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
3252568WWM,EAP,Custom 3252568WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Med/reg #3416,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
3250441WWM,EAP,Custom 3250441WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Medium/short#3310,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
3252566WWM,EAP,Custom 3252566WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Sm/reg #3130,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
3252563WWM,EAP,Custom 3252563WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Xlg/lng #3182,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
3252564WWM,EAP,Custom 3252564WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Ted Sox Xlg/reg #3181,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
3253789WWM,EAP,Custom 3253789WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Thoracic Vent 13 Fr# Tv13,1,601, 570.95 ,588.98, 570.95 , 582.97 , 570.95 ,Current Medicare Rates,582.97,576.96,Included in per diem,570.95,Included in ER Case rate,570.95,570.95, 588.98 ,540.9
3250257WWM,EAP,Custom 3250257WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Tray Lumbar Punct#4301csp,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
3250817WWM,EAP,Custom 3250817WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Tray Lumbar/infant#4302cs,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
3250446WWM,EAP,Custom 3250446WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Tray Thorocentesis,1,132, 125.40 ,129.36, 125.40 , 128.04 , 125.40 ,Current Medicare Rates,128.04,126.72,Included in per diem,125.4,Included in ER Case rate,125.4,125.4, 129.36 ,118.8
3250453WWM,EAP,Custom 3250453WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Trocar Cath 28fr #565044,1,149, 141.55 ,146.02, 141.55 , 144.53 , 141.55 ,Current Medicare Rates,144.53,143.04,Included in per diem,141.55,Included in ER Case rate,141.55,141.55, 146.02 ,134.1
3254102WWM,EAP,Custom 3254102WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Tube Gastrostomy #0120241-7,1,227, 215.65 ,222.46, 215.65 , 220.19 , 215.65 ,Current Medicare Rates,220.19,217.92,Included in per diem,215.65,Included in ER Case rate,215.65,215.65, 222.46 ,204.3
3250615WWM,EAP,Custom 3250615WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Tube Ss Reflux Val#266197,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
3253556WWM,EAP,Custom 3253556WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Tubing Hot Line #l-70,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
3254189WWM,EAP,Custom 3254189WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Urinary Drain Bag Kdl3057h,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3250456WWM,EAP,Custom 3250456WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Urinary Drain Bags #3057,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
3250458WWM,EAP,Custom 3250458WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Urinary Leg Dr M #150102,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,Included in per diem,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
3250457WWM,EAP,Custom 3250457WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Urine Meter #153202,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
3253029WWM,EAP,Custom 3253029WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Venaflow Calf Cuff,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
3254202WWM,EAP,Custom 3254202WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Venaflow Calf Cuff Elite #3040,1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
3254124WWM,EAP,Custom 3254124WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Vest Restraint #3311xl,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
3254123WWM,EAP,Custom 3254123WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Vest Restraint Lg #24663-060,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
3254122WWM,EAP,Custom 3254122WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Vest Restraint Md #24663-030,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
3254121WWM,EAP,Custom 3254121WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Vest Restraintsm #24663-020,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
3254113WWM,EAP,Custom 3254113WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc W/f Long L/lg #410109,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3254112WWM,EAP,Custom 3254112WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc W/f Long L/med #410108,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3254111WWM,EAP,Custom 3254111WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc W/f Long L/sm #410108,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3254114WWM,EAP,Custom 3254114WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc W/f Long L/xl #410110,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3254117WWM,EAP,Custom 3254117WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc W/f Long R/lg #410105,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3254116WWM,EAP,Custom 3254116WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc W/f Long R/med #410104,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3254115WWM,EAP,Custom 3254115WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc W/f Long R/sm #410103,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
3253787WWM,EAP,Custom 3253787WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Waffle Heel Elevator #345,1,145, 137.75 ,142.1, 137.75 , 140.65 , 137.75 ,Current Medicare Rates,140.65,139.2,Included in per diem,137.75,Included in ER Case rate,137.75,137.75, 142.10 ,130.5
3253785WWM,EAP,Custom 3253785WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Waffle Mattres Overlay#10,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
3253673WWM,EAP,Custom 3253673WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Wound Vac & Supplies,1,230, 218.50 ,225.4, 218.50 , 223.10 , 218.50 ,Current Medicare Rates,223.1,220.8,Included in per diem,218.5,Included in ER Case rate,218.5,218.5, 225.40 ,207
3253760WWM,EAP,Custom 3253760WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hc Wrist Restraint #2528-1,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,Included in per diem,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
3254029WWM,EAP,Custom 3254029WWM,,0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION,Hcor Screw Teno #ar-1562ps,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,Included in per diem,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
27110047,EAP,Custom 27110047,,0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY,Hc Misc Supply,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
3254093WWM,EAP,Custom 3254093WWM,,0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY,Hc Drill Cannulated 10,1,499, 474.05 ,489.02, 474.05 , 484.03 , 474.05 ,Current Medicare Rates,484.03,479.04,Included in per diem,474.05,Included in ER Case rate,474.05,474.05, 489.02 ,449.1
3254094WWM,EAP,Custom 3254094WWM,,0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY,Hc Drill Cannulated 10.5,1,499, 474.05 ,489.02, 474.05 , 484.03 , 474.05 ,Current Medicare Rates,484.03,479.04,Included in per diem,474.05,Included in ER Case rate,474.05,474.05, 489.02 ,449.1
3253773WWM,EAP,Custom 3253773WWM,,0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY,Hc Or Needle Injector,1,143, 135.85 ,140.14, 135.85 , 138.71 , 135.85 ,Current Medicare Rates,138.71,137.28,Included in per diem,135.85,Included in ER Case rate,135.85,135.85, 140.14 ,128.7
4170199WWM,EAP,Custom 4170199WWM,,0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY,Hc Set-baxter Male Luer Lock,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
3254083WWM,EAP,Custom 3254083WWM,,0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY,HC Torpedo 5mm   AR-8500TD,1,257, 244.15 ,251.86, 244.15 , 249.29 , 244.15 ,Current Medicare Rates,249.29,246.72,Included in per diem,244.15,Included in ER Case rate,244.15,244.15, 251.86 ,231.3
27410246,EAP,HCPCS L3933,,0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES,Hc Fo  No Joints  Custom,1,209, 198.55 ,204.82, 198.55 , 202.73 , 198.55 ,Current Medicare Rates,202.73,200.64,Included in per diem,198.55,Included in ER Case rate,198.55,198.55, 204.82 ,188.1
27410241,EAP,HCPCS L3808,,0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES,Hc Whfo Rigid  No Joints Custom,1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
27410120,EAP,HCPCS L3807,,0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES,Hc Wrist Splint/velcro,1,123, 116.85 ,120.54, 116.85 , 119.31 , 116.85 ,Current Medicare Rates,119.31,118.08,Included in per diem,116.85,Included in ER Case rate,116.85,116.85, 120.54 ,110.7
3216795WWM,EAP,HCPCS V2632,,0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS,Hc Cataract Surgery Pack,1,1903," 1,807.85 ",1864.94," 1,807.85 "," 1,845.91 "," 1,807.85 ",Current Medicare Rates,1845.91,1826.88,Included in per diem,1807.85,Included in ER Case rate,1807.85,1807.85," 1,864.94 ",1712.7
3253061WWM,SUP,Custom 27810126,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,FIBERWIRE #2    #AR-7200,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
3253701WWM,EAP,Custom 3253701WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc  Or Mesh Soft 4x6#0117010,1,366, 347.70 ,358.68, 347.70 , 355.02 , 347.70 ,Current Medicare Rates,355.02,351.36,Included in per diem,347.7,Included in ER Case rate,347.7,347.7, 358.68 ,329.4
3253543WWM,EAP,Custom 3253543WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or 1.0mm Cable With Crimp,1,1382," 1,312.90 ",1354.36," 1,312.90 "," 1,340.54 "," 1,312.90 ",Current Medicare Rates,1340.54,1326.72,Included in per diem,1312.9,Included in ER Case rate,1312.9,1312.9," 1,354.36 ",1243.8
3253637WWM,EAP,Custom 3253637WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Allograft Btb 17817000,1,4401," 4,180.95 ",4312.98," 4,180.95 "," 4,268.97 "," 4,180.95 ",Current Medicare Rates,4268.97,4224.96,Included in per diem,4180.95,Included in ER Case rate,4180.95,4180.95," 4,312.98 ",3960.9
3253621WWM,EAP,Custom 3253621WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Allograft P.l.#0741531,1,5914," 5,618.30 ",5795.72," 5,618.30 "," 5,736.58 "," 5,618.30 ",Current Medicare Rates,5736.58,5677.44,Included in per diem,5618.3,Included in ER Case rate,5618.3,5618.3," 5,795.72 ",5322.6
3253630WWM,EAP,Custom 3253630WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Allograft Pl,1,4401," 4,180.95 ",4312.98," 4,180.95 "," 4,268.97 "," 4,180.95 ",Current Medicare Rates,4268.97,4224.96,Included in per diem,4180.95,Included in ER Case rate,4180.95,4180.95," 4,312.98 ",3960.9
3253643WWM,EAP,Custom 3253643WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Allograft Tend No Bone,1,1675," 1,591.25 ",1641.5," 1,591.25 "," 1,624.75 "," 1,591.25 ",Current Medicare Rates,1624.75,1608,Included in per diem,1591.25,Included in ER Case rate,1591.25,1591.25," 1,641.50 ",1507.5
3253674WWM,EAP,Custom 3253674WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Allograft Tend No Bone,1,2010," 1,909.50 ",1969.8," 1,909.50 "," 1,949.70 "," 1,909.50 ",Current Medicare Rates,1949.7,1929.6,Included in per diem,1909.5,Included in ER Case rate,1909.5,1909.5," 1,969.80 ",1809
3253089WWM,EAP,Custom 3253089WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Clip Applier,1,264.6, 251.37 ,259.31, 251.37 , 256.66 , 251.37 ,Current Medicare Rates,256.66,254.02,Included in per diem,251.37,Included in ER Case rate,251.37,251.37, 259.31 ,238.14
3250387WWM,EAP,Custom 3250387WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Colon Clip#hx2004135,1,180, 171.00 ,176.4, 171.00 , 174.60 , 171.00 ,Current Medicare Rates,174.6,172.8,Included in per diem,171,Included in ER Case rate,171,171, 176.40 ,162
3253437WWM,EAP,Custom 3253437WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Endo Clip Applier Med,1,672, 638.40 ,658.56, 638.40 , 651.84 , 638.40 ,Current Medicare Rates,651.84,645.12,Included in per diem,638.4,Included in ER Case rate,638.4,638.4, 658.56 ,604.8
3259194WWM,EAP,Custom 3259194WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Implant Toe #375-0001,1,2085," 1,980.75 ",2043.3," 1,980.75 "," 2,022.45 "," 1,980.75 ",Current Medicare Rates,2022.45,2001.6,Included in per diem,1980.75,Included in ER Case rate,1980.75,1980.75," 2,043.30 ",1876.5
3253668WWM,EAP,Custom 3253668WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip #er320,1,277.00, 263.15 ,271.46, 263.15 , 268.69 , 263.15 ,Current Medicare Rates,268.69,265.92,Included in per diem,263.15,Included in ER Case rate,263.15,263.15, 271.46 ,249.3
3252595WWM,EAP,Custom 3252595WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip App L #er420,1,275, 261.25 ,269.5, 261.25 , 266.75 , 261.25 ,Current Medicare Rates,266.75,264,Included in per diem,261.25,Included in ER Case rate,261.25,261.25, 269.50 ,247.5
3252594WWM,EAP,Custom 3252594WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip App M#er320,1,207, 196.65 ,202.86, 196.65 , 200.79 , 196.65 ,Current Medicare Rates,200.79,198.72,Included in per diem,196.65,Included in ER Case rate,196.65,196.65, 202.86 ,186.3
3252716WWM,EAP,Custom 3252716WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Ex #lt400,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
3253282WWM,EAP,Custom 3253282WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Lg #mcl20,1,264, 250.80 ,258.72, 250.80 , 256.08 , 250.80 ,Current Medicare Rates,256.08,253.44,Included in per diem,250.8,Included in ER Case rate,250.8,250.8, 258.72 ,237.6
3253752WWM,EAP,Custom 3253752WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Max #el5ml,1,368, 349.60 ,360.64, 349.60 , 356.96 , 349.60 ,Current Medicare Rates,356.96,353.28,Included in per diem,349.6,Included in ER Case rate,349.6,349.6, 360.64 ,331.2
3253828WWM,EAP,Custom 3253828WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Med #ls200,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
3253281WWM,EAP,Custom 3253281WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Med #mcm20,1,228, 216.60 ,223.44, 216.60 , 221.16 , 216.60 ,Current Medicare Rates,221.16,218.88,Included in per diem,216.6,Included in ER Case rate,216.6,216.6, 223.44 ,205.2
3250427WWM,EAP,Custom 3250427WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Med Lc3,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
3250426WWM,EAP,Custom 3250426WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Sm #lc20,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
3253827WWM,EAP,Custom 3253827WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Liga Clip Sm #ls100,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
3253702WWM,EAP,Custom 3253702WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh 3dmax Md/lt,1,414, 393.30 ,405.72, 393.30 , 401.58 , 393.30 ,Current Medicare Rates,401.58,397.44,Included in per diem,393.3,Included in ER Case rate,393.3,393.3, 405.72 ,372.6
3253703WWM,EAP,Custom 3253703WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh 3dmax Md/rt,1,414, 393.30 ,405.72, 393.30 , 401.58 , 393.30 ,Current Medicare Rates,401.58,397.44,Included in per diem,393.3,Included in ER Case rate,393.3,393.3, 405.72 ,372.6
3253664WWM,EAP,Custom 3253664WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Bard 3x6 #dc01126,1,282.00, 267.90 ,276.36, 267.90 , 273.54 , 267.90 ,Current Medicare Rates,273.54,270.72,Included in per diem,267.9,Included in ER Case rate,267.9,267.9, 276.36 ,253.8
3253190WWM,EAP,Custom 3253190WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Bard Lg #0112770,1,353, 335.35 ,345.94, 335.35 , 342.41 , 335.35 ,Current Medicare Rates,342.41,338.88,Included in per diem,335.35,Included in ER Case rate,335.35,335.35, 345.94 ,317.7
3253189WWM,EAP,Custom 3253189WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Bard Med #0112760,1,612, 581.40 ,599.76, 581.40 , 593.64 , 581.40 ,Current Medicare Rates,593.64,587.52,Included in per diem,581.4,Included in ER Case rate,581.4,581.4, 599.76 ,550.8
3252598WWM,EAP,Custom 3252598WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Bard Sm #0112750,1,608, 577.60 ,595.84, 577.60 , 589.76 , 577.60 ,Current Medicare Rates,589.76,583.68,Included in per diem,577.6,Included in ER Case rate,577.6,577.6, 595.84 ,547.2
3250618WWM,EAP,Custom 3250618WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Bard Xlg #0112780,1,422, 400.90 ,413.56, 400.90 , 409.34 , 400.90 ,Current Medicare Rates,409.34,405.12,Included in per diem,400.9,Included in ER Case rate,400.9,400.9, 413.56 ,379.8
3253698WWM,EAP,Custom 3253698WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composite 10x8,1,2502," 2,376.90 ",2451.96," 2,376.90 "," 2,426.94 "," 2,376.90 ",Current Medicare Rates,2426.94,2401.92,Included in per diem,2376.9,Included in ER Case rate,2376.9,2376.9," 2,451.96 ",2251.8
3253697WWM,EAP,Custom 3253697WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composite 12x8,1,3422," 3,250.90 ",3353.56," 3,250.90 "," 3,319.34 "," 3,250.90 ",Current Medicare Rates,3319.34,3285.12,Included in per diem,3250.9,Included in ER Case rate,3250.9,3250.9," 3,353.56 ",3079.8
3253696WWM,EAP,Custom 3253696WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composite 14x11,1,4062," 3,858.90 ",3980.76," 3,858.90 "," 3,940.14 "," 3,858.90 ",Current Medicare Rates,3940.14,3899.52,Included in per diem,3858.9,Included in ER Case rate,3858.9,3858.9," 3,980.76 ",3655.8
3253699WWM,EAP,Custom 3253699WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composite 6x4,1,951.00, 903.45 ,931.98, 903.45 , 922.47 , 903.45 ,Current Medicare Rates,922.47,912.96,Included in per diem,903.45,Included in ER Case rate,903.45,903.45, 931.98 ,855.9
3253707WWM,EAP,Custom 3253707WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composix 10x14,1,4022," 3,820.90 ",3941.56," 3,820.90 "," 3,901.34 "," 3,820.90 ",Current Medicare Rates,3901.34,3861.12,Included in per diem,3820.9,Included in ER Case rate,3820.9,3820.9," 3,941.56 ",3619.8
3253177WWM,EAP,Custom 3253177WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composix 3x6,1,898, 853.10 ,880.04, 853.10 , 871.06 , 853.10 ,Current Medicare Rates,871.06,862.08,Included in per diem,853.1,Included in ER Case rate,853.1,853.1, 880.04 ,808.2
3253704WWM,EAP,Custom 3253704WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composix 4x6,1,909, 863.55 ,890.82, 863.55 , 881.73 , 863.55 ,Current Medicare Rates,881.73,872.64,Included in per diem,863.55,Included in ER Case rate,863.55,863.55, 890.82 ,818.1
3252850WWM,EAP,Custom 3252850WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composix 4x8,1,937, 890.15 ,918.26, 890.15 , 908.89 , 890.15 ,Current Medicare Rates,908.89,899.52,Included in per diem,890.15,Included in ER Case rate,890.15,890.15, 918.26 ,843.3
3253705WWM,EAP,Custom 3253705WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composix 6x8,1,"1,436.00"," 1,364.20 ",1407.28," 1,364.20 "," 1,392.92 "," 1,364.20 ",Current Medicare Rates,1392.92,1378.56,Included in per diem,1364.2,Included in ER Case rate,1364.2,1364.2," 1,407.28 ",1292.4
3253706WWM,EAP,Custom 3253706WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composix 8x10,1,3053," 2,900.35 ",2991.94," 2,900.35 "," 2,961.41 "," 2,900.35 ",Current Medicare Rates,2961.41,2930.88,Included in per diem,2900.35,Included in ER Case rate,2900.35,2900.35," 2,991.94 ",2747.7
3253711WWM,EAP,Custom 3253711WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Composix 8x6#pco2,1,"1,646.00"," 1,563.70 ",1613.08," 1,563.70 "," 1,596.62 "," 1,563.70 ",Current Medicare Rates,1596.62,1580.16,Included in per diem,1563.7,Included in ER Case rate,1563.7,1563.7," 1,613.08 ",1481.4
3253363WWM,EAP,Custom 3253363WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Med Circle Strap,1,1100," 1,045.00 ",1078," 1,045.00 "," 1,067.00 "," 1,045.00 ",Current Medicare Rates,1067,1056,Included in per diem,1045,Included in ER Case rate,1045,1045," 1,078.00 ",990
3252708WWM,EAP,Custom 3252708WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Monofilament 1x4,1,221, 209.95 ,216.58, 209.95 , 214.37 , 209.95 ,Current Medicare Rates,214.37,212.16,Included in per diem,209.95,Included in ER Case rate,209.95,209.95, 216.58 ,198.9
3252707WWM,EAP,Custom 3252707WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Monofilament 3x6,1,289.00, 274.55 ,283.22, 274.55 , 280.33 , 274.55 ,Current Medicare Rates,280.33,277.44,Included in per diem,274.55,Included in ER Case rate,274.55,274.55, 283.22 ,260.1
3253167WWM,EAP,Custom 3253167WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Proceed #pcdr1,1,901, 855.95 ,882.98, 855.95 , 873.97 , 855.95 ,Current Medicare Rates,873.97,864.96,Included in per diem,855.95,Included in ER Case rate,855.95,855.95, 882.98 ,810.9
3253700WWM,EAP,Custom 3253700WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Soft 3x6#0117009,1,328.00, 311.60 ,321.44, 311.60 , 318.16 , 311.60 ,Current Medicare Rates,318.16,314.88,Included in per diem,311.6,Included in ER Case rate,311.6,311.6, 321.44 ,295.2
3253435WWM,EAP,Custom 3253435WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Surg 2x3 #1953,1,160, 152.00 ,156.8, 152.00 , 155.20 , 152.00 ,Current Medicare Rates,155.2,153.6,Included in per diem,152,Included in ER Case rate,152,152, 156.80 ,144
3253434WWM,EAP,Custom 3253434WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Surg 4x8 #1952,1,218, 207.10 ,213.64, 207.10 , 211.46 , 207.10 ,Current Medicare Rates,211.46,209.28,Included in per diem,207.1,Included in ER Case rate,207.1,207.1, 213.64 ,196.2
3253751WWM,EAP,Custom 3253751WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Vent Sm #0010301,1,1005, 954.75 ,984.9, 954.75 , 974.85 , 954.75 ,Current Medicare Rates,974.85,964.8,Included in per diem,954.75,Included in ER Case rate,954.75,954.75, 984.90 ,904.5
3253277WWM,EAP,Custom 3253277WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Mesh Ventralex #001030,1,2523," 2,396.85 ",2472.54," 2,396.85 "," 2,447.31 "," 2,396.85 ",Current Medicare Rates,2447.31,2422.08,Included in per diem,2396.85,Included in ER Case rate,2396.85,2396.85," 2,472.54 ",2270.7
3252719WWM,EAP,Custom 3252719WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Patch Hern/11x14#10105,1,899, 854.05 ,881.02, 854.05 , 872.03 , 854.05 ,Current Medicare Rates,872.03,863.04,Included in per diem,854.05,Included in ER Case rate,854.05,854.05, 881.02 ,809.1
3252718WWM,EAP,Custom 3252718WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Patch Hern/8/8#010103,1,863, 819.85 ,845.74, 819.85 , 837.11 , 819.85 ,Current Medicare Rates,837.11,828.48,Included in per diem,819.85,Included in ER Case rate,819.85,819.85, 845.74 ,776.7
3252717WWM,EAP,Custom 3252717WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Patch Hern/80x12#10101,1,737, 700.15 ,722.26, 700.15 , 714.89 , 700.15 ,Current Medicare Rates,714.89,707.52,Included in per diem,700.15,Included in ER Case rate,700.15,700.15, 722.26 ,663.3
3253851WWM,EAP,Custom 3253851WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Permafix 15 Stap#01130,1,814, 773.30 ,797.72, 773.30 , 789.58 , 773.30 ,Current Medicare Rates,789.58,781.44,Included in per diem,773.3,Included in ER Case rate,773.3,773.3, 797.72 ,732.6
3253740WWM,EAP,Custom 3253740WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 1/3 Tub 6 Hole,1,174, 165.30 ,170.52, 165.30 , 168.78 , 165.30 ,Current Medicare Rates,168.78,167.04,Included in per diem,165.3,Included in ER Case rate,165.3,165.3, 170.52 ,156.6
3253224WWM,EAP,Custom 3253224WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 3 Hole #242.03,1,180, 171.00 ,176.4, 171.00 , 174.60 , 171.00 ,Current Medicare Rates,174.6,172.8,Included in per diem,171,Included in ER Case rate,171,171, 176.40 ,162
3253230WWM,EAP,Custom 3253230WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 3 Hole #243.13,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253225WWM,EAP,Custom 3253225WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 4 Hole #242.04,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
3253231WWM,EAP,Custom 3253231WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 4 Hole #243.14,1,168, 159.60 ,164.64, 159.60 , 162.96 , 159.60 ,Current Medicare Rates,162.96,161.28,Included in per diem,159.6,Included in ER Case rate,159.6,159.6, 164.64 ,151.2
3253226WWM,EAP,Custom 3253226WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 5 Hole #242.05,1,204, 193.80 ,199.92, 193.80 , 197.88 , 193.80 ,Current Medicare Rates,197.88,195.84,Included in per diem,193.8,Included in ER Case rate,193.8,193.8, 199.92 ,183.6
3253232WWM,EAP,Custom 3253232WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 5 Hole #243.15,1,180, 171.00 ,176.4, 171.00 , 174.60 , 171.00 ,Current Medicare Rates,174.6,172.8,Included in per diem,171,Included in ER Case rate,171,171, 176.40 ,162
3253227WWM,EAP,Custom 3253227WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 6 Hole #242.06,1,227, 215.65 ,222.46, 215.65 , 220.19 , 215.65 ,Current Medicare Rates,220.19,217.92,Included in per diem,215.65,Included in ER Case rate,215.65,215.65, 222.46 ,204.3
3253228WWM,EAP,Custom 3253228WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 7 Hole #242.07,1,236, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
3253229WWM,EAP,Custom 3253229WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate 8 Hole #242.08,1,253, 240.35 ,247.94, 240.35 , 245.41 , 240.35 ,Current Medicare Rates,245.41,242.88,Included in per diem,240.35,Included in ER Case rate,240.35,240.35, 247.94 ,227.7
3253238WWM,EAP,Custom 3253238WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate L-lt 2 Hole #243,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253236WWM,EAP,Custom 3253236WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate L-lt 3 Hole #242,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253237WWM,EAP,Custom 3253237WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate L-rt 2 Hole #243,1,170, 161.50 ,166.6, 161.50 , 164.90 , 161.50 ,Current Medicare Rates,164.9,163.2,Included in per diem,161.5,Included in ER Case rate,161.5,161.5, 166.60 ,153
3253235WWM,EAP,Custom 3253235WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate L-rt 3 Hole #242,1,202.00, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253661WWM,EAP,Custom 3253661WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate Semi Tub 5 Hole,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
3253662WWM,EAP,Custom 3253662WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate Semi Tub 6 Hole,1,179, 170.05 ,175.42, 170.05 , 173.63 , 170.05 ,Current Medicare Rates,173.63,171.84,Included in per diem,170.05,Included in ER Case rate,170.05,170.05, 175.42 ,161.1
3253234WWM,EAP,Custom 3253234WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate T-2 Hole #243.41,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253233WWM,EAP,Custom 3253233WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Plate T-3 Hole #242.41,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
3253784WWM,EAP,Custom 3253784WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Port Smart Ct #ct75sts,1,1075," 1,021.25 ",1053.5," 1,021.25 "," 1,042.75 "," 1,021.25 ",Current Medicare Rates,1042.75,1032,Included in per diem,1021.25,Included in ER Case rate,1021.25,1021.25," 1,053.50 ",967.5
3252911WWM,EAP,Custom 3252911WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Portacath#0603590,1,2486," 2,361.70 ",2436.28," 2,361.70 "," 2,411.42 "," 2,361.70 ",Current Medicare Rates,2411.42,2386.56,Included in per diem,2361.7,Included in ER Case rate,2361.7,2361.7," 2,436.28 ",2237.4
3253509WWM,EAP,Custom 3253509WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Power Port #1808000,1,1607," 1,526.65 ",1574.86," 1,526.65 "," 1,558.79 "," 1,526.65 ",Current Medicare Rates,1558.79,1542.72,Included in per diem,1526.65,Included in ER Case rate,1526.65,1526.65," 1,574.86 ",1446.3
3253695WMM,EAP,Custom 3253695WMM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Protack #174006,1,926, 879.70 ,907.48, 879.70 , 898.22 , 879.70 ,Current Medicare Rates,898.22,888.96,Included in per diem,879.7,Included in ER Case rate,879.7,879.7, 907.48 ,833.4
3253202WWM,EAP,Custom 3253202WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 1.5x10 #200.010,1,108.00, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
3253203WWM,EAP,Custom 3253203WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 1.5x12 #200.012,1,108, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
3253204WWM,EAP,Custom 3253204WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 1.5x14 #200.014,1,108, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
3253205WWM,EAP,Custom 3253205WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 1.5x16 #200.016,1,108.00, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
3253200WWM,EAP,Custom 3253200WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 1.5x6 #200.006,1,108.00, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
3253201WWM,EAP,Custom 3253201WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 1.5x8 #200.008,1,108.00, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
3253208WWM,EAP,Custom 3253208WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x10 #201.010,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253209WWM,EAP,Custom 3253209WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x12 #201.012,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253210WWM,EAP,Custom 3253210WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x14 #201.014,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253211WWM,EAP,Custom 3253211WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x16 #201.016,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253212WWM,EAP,Custom 3253212WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x18 #201.018,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253213WWM,EAP,Custom 3253213WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x20 #201.020,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253206WWM,EAP,Custom 3253206WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x6 #201.006,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
3253207WWM,EAP,Custom 3253207WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.0x8 #201.008,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253216WWM,EAP,Custom 3253216WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x10 #202.010,1,109.00, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253217WWM,EAP,Custom 3253217WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x12 #202.012,1,109.00, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253218WWM,EAP,Custom 3253218WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x14 #202.014,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253219WWM,EAP,Custom 3253219WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x16 #202.016,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253301WWM,EAP,Custom 3253301WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x16 #202.816,1,119.00, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3253220WWM,EAP,Custom 3253220WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x18 #202.018,1,109.00, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253302WWM,EAP,Custom 3253302WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x18 #202.818,1,105, 99.75 ,102.9, 99.75 , 101.85 , 99.75 ,Current Medicare Rates,101.85,100.8,Included in per diem,99.75,Included in ER Case rate,99.75,99.75, 102.90 ,94.5
3253221WWM,EAP,Custom 3253221WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x20 #202.020,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253300WWM,EAP,Custom 3253300WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x20 #202.820,1,119, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3253222WWM,EAP,Custom 3253222WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x22 #202.022,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253223WWM,EAP,Custom 3253223WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x24 #202.024,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
3253214WWM,EAP,Custom 3253214WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x6 #202.006,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253215WWM,EAP,Custom 3253215WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 2.7x8 #202.008,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253741WWM,EAP,Custom 3253741WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 14mm,1,167, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253735WWM,EAP,Custom 3253735WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 16mm,1,167, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253742WWM,EAP,Custom 3253742WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 18mm,1,167, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253736WWM,EAP,Custom 3253736WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 20mm,1,167, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253737WWM,EAP,Custom 3253737WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 22mm,1,167, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253738WWM,EAP,Custom 3253738WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 24mm,1,167, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253739WWM,EAP,Custom 3253739WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 30mm,1,$167.00, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253745WWM,EAP,Custom 3253745WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 3.5/ 38mm#2348-0,1,167, 158.65 ,163.66, 158.65 , 161.99 , 158.65 ,Current Medicare Rates,161.99,160.32,Included in per diem,158.65,Included in ER Case rate,158.65,158.65, 163.66 ,150.3
3253725WWM,EAP,Custom 3253725WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 4.0mm/ 45mm,1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
3253726WWM,EAP,Custom 3253726WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 4.0mm/ 50mm,1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
3253552WWM,EAP,Custom 3253552WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 4.5 Cann,1,357, 339.15 ,349.86, 339.15 , 346.29 , 339.15 ,Current Medicare Rates,346.29,342.72,Included in per diem,339.15,Included in ER Case rate,339.15,339.15, 349.86 ,321.3
3253657WWM,EAP,Custom 3253657WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 4.5mm/ 18mm,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253658WWM,EAP,Custom 3253658WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 4.5mm/ 20mm,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253659WWM,EAP,Custom 3253659WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 4.5mm/ 22mm,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253660WWM,EAP,Custom 3253660WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 4.5mm/ 50mm,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
3253843WWM,EAP,Custom 3253843WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 6.5x75 #2347-024,1,163, 154.85 ,159.74, 154.85 , 158.11 , 154.85 ,Current Medicare Rates,158.11,156.48,Included in per diem,154.85,Included in ER Case rate,154.85,154.85, 159.74 ,146.7
3253844WWM,EAP,Custom 3253844WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 6.5x90 #2347-024,1,163, 154.85 ,159.74, 154.85 , 158.11 , 154.85 ,Current Medicare Rates,158.11,156.48,Included in per diem,154.85,Included in ER Case rate,154.85,154.85, 159.74 ,146.7
3253558WWM,EAP,Custom 3253558WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw 70mm#4845-70-08,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,Included in per diem,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
3253628WWM,EAP,Custom 3253628WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Arthrex 8x25,1,348.00, 330.60 ,341.04, 330.60 , 337.56 , 330.60 ,Current Medicare Rates,337.56,334.08,Included in per diem,330.6,Included in ER Case rate,330.6,330.6, 341.04 ,313.2
3253566WWM,EAP,Custom 3253566WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Arthrex 8x25,1,371, 352.45 ,363.58, 352.45 , 359.87 , 352.45 ,Current Medicare Rates,359.87,356.16,Included in per diem,352.45,Included in ER Case rate,352.45,352.45, 363.58 ,333.9
3253825WWM,EAP,Custom 3253825WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Bio 8x23#ar1380c,1,821, 779.95 ,804.58, 779.95 , 796.37 , 779.95 ,Current Medicare Rates,796.37,788.16,Included in per diem,779.95,Included in ER Case rate,779.95,779.95, 804.58 ,738.9
3253818WWM,EAP,Custom 3253818WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Bio 8x28#ar5028c,1,821, 779.95 ,804.58, 779.95 , 796.37 , 779.95 ,Current Medicare Rates,796.37,788.16,Included in per diem,779.95,Included in ER Case rate,779.95,779.95, 804.58 ,738.9
3253764WWM,EAP,Custom 3253764WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Cort 3.5mm/20mm,1,98.00, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
3253762WWM,EAP,Custom 3253762WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Cort 4.5mm/24mm,1,106.00, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
3253763WWM,EAP,Custom 3253763WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Cort 4.5mm/26mm,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
3253629WWM,EAP,Custom 3253629WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Interf 8x25,1,348, 330.60 ,341.04, 330.60 , 337.56 , 330.60 ,Current Medicare Rates,337.56,334.08,Included in per diem,330.6,Included in ER Case rate,330.6,330.6, 341.04 ,313.2
3253615WWM,EAP,Custom 3253615WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Interf 9x25#ar13,1,371.00, 352.45 ,363.58, 352.45 , 359.87 , 352.45 ,Current Medicare Rates,359.87,356.16,Included in per diem,352.45,Included in ER Case rate,352.45,352.45, 363.58 ,333.9
3253613WWM,EAP,Custom 3253613WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Malleo 60#4845-0,1,119.00, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3253614WWM,EAP,Custom 3253614WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Malleo 70#4845-0,1,119.00, 113.05 ,116.62, 113.05 , 115.43 , 113.05 ,Current Medicare Rates,115.43,114.24,Included in per diem,113.05,Included in ER Case rate,113.05,113.05, 116.62 ,107.1
3253616WWM,EAP,Custom 3253616WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Soft 9x25#ar1391,1,371, 352.45 ,363.58, 352.45 , 359.87 , 352.45 ,Current Medicare Rates,359.87,356.16,Included in per diem,352.45,Included in ER Case rate,352.45,352.45, 363.58 ,333.9
3253770WWM,EAP,Custom 3253770WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Super Quick#2229,1,877, 833.15 ,859.46, 833.15 , 850.69 , 833.15 ,Current Medicare Rates,850.69,841.92,Included in per diem,833.15,Included in ER Case rate,833.15,833.15, 859.46 ,789.3
3253603WWM,EAP,Custom 3253603WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw Tenodesis 7x23,1,944.00, 896.80 ,925.12, 896.80 , 915.68 , 896.80 ,Current Medicare Rates,915.68,906.24,Included in per diem,896.8,Included in ER Case rate,896.8,896.8, 925.12 ,849.6
3253239WWM,EAP,Custom 3253239WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Screw-washer 7.0 #219,1,103.00, 97.85 ,100.94, 97.85 , 99.91 , 97.85 ,Current Medicare Rates,99.91,98.88,Included in per diem,97.85,Included in ER Case rate,97.85,97.85, 100.94 ,92.7
3253713WWM,EAP,Custom 3253713WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Stein Pin 2.0#18700159,1,93.00, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,Included in per diem,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
3253714WWM,EAP,Custom 3253714WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Stein Pin 2.4#18700259,1,88.00, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
3253715WWM,EAP,Custom 3253715WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Stein Pin 2.8#18700359,1,88.00, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
3253716WWM,EAP,Custom 3253716WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Stein Pin 3.2#18700459,1,88.00, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
3253626WWM,EAP,Custom 3253626WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Vilex Hemi Implant,1,1866," 1,772.70 ",1828.68," 1,772.70 "," 1,810.02 "," 1,772.70 ",Current Medicare Rates,1810.02,1791.36,Included in per diem,1772.7,Included in ER Case rate,1772.7,1772.7," 1,828.68 ",1679.4
3253845WWM,EAP,Custom 3253845WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Washer #4900-065-51,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,Included in per diem,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
3252619WWM,EAP,Custom 3252619WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire C 045x5#5050-248,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
3252618WWM,EAP,Custom 3252618WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire C 062x5 #5050-249,1,53.00, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
3252641WWM,EAP,Custom 3252641WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire Guide #aw14735,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
3252613WWM,EAP,Custom 3252613WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire K 035x6 #186058,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252615WWM,EAP,Custom 3252615WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire K 035x9 #186-0169,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252616WWM,EAP,Custom 3252616WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire K 045x9 #1860269,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252614WWM,EAP,Custom 3252614WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire K 062x6 #186090,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3252617WWM,EAP,Custom 3252617WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire K 062x9 #1860369,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
3253270WWM,EAP,Custom 3253270WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire K.thrd 0.045,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
3253271WWM,EAP,Custom 3253271WWM,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Or Wire K.thrd 0.062,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
4090101WWM,EAP,HCPCS L3010,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Orthotic - Foot Insert - Right,1,217, 206.15 ,212.66, 206.15 , 210.49 , 206.15 ,Current Medicare Rates,210.49,208.32,Included in per diem,206.15,Included in ER Case rate,206.15,206.15, 212.66 ,195.3
4090102WWM,EAP,HCPCS L3010,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Orthotics - Foot Insert,1,217, 206.15 ,212.66, 206.15 , 210.49 , 206.15 ,Current Medicare Rates,210.49,208.32,Included in per diem,206.15,Included in ER Case rate,206.15,206.15, 212.66 ,195.3
3254081WWM,EAP,HCPCS C1713,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,HC Speedbridge Implant  AR-2600SBS-4,1,3329," 3,162.55 ",3262.42," 3,162.55 "," 3,229.13 "," 3,162.55 ",Current Medicare Rates,3229.13,3195.84,Included in per diem,3162.55,Included in ER Case rate,3162.55,3162.55," 3,262.42 ",2996.1
3254092WWM,EAP,HCPCS C1713,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,Hc Speedgraft / Allograft,1,4669," 4,435.55 ",4575.62," 4,435.55 "," 4,528.93 "," 4,435.55 ",Current Medicare Rates,4528.93,4482.24,Included in per diem,4435.55,Included in ER Case rate,4435.55,4435.55," 4,575.62 ",4202.1
3254082WWM,EAP,HCPCS C1713,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,HC Suture Anchor  AR-2324BCC,1,1021, 969.95 ,1000.58, 969.95 , 990.37 , 969.95 ,Current Medicare Rates,990.37,980.16,Included in per diem,969.95,Included in ER Case rate,969.95,969.95," 1,000.58 ",918.9
3254079WWM,EAP,HCPCS C1713,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,HC Tenodesis Swiveloc   AR-1662PSL-8,1,775, 736.25 ,759.5, 736.25 , 751.75 , 736.25 ,Current Medicare Rates,751.75,744,Included in per diem,736.25,Included in ER Case rate,736.25,736.25, 759.50 ,697.5
3254080WWM,EAP,HCPCS C1713,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,HC Tenodesis Swiveloc   AR-1662PSL-9,1,775, 736.25 ,759.5, 736.25 , 751.75 , 736.25 ,Current Medicare Rates,751.75,744,Included in per diem,736.25,Included in ER Case rate,736.25,736.25, 759.50 ,697.5
3254078WWM,EAP,HCPCS C1713,,0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT,HC Tenodesis Swiveloc  AR-1662PSL-7,1,775, 736.25 ,759.5, 736.25 , 751.75 , 736.25 ,Current Medicare Rates,751.75,744,Included in per diem,736.25,Included in ER Case rate,736.25,736.25, 759.50 ,697.5
31900012,EAP,CPT® 84270,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc  Assay Of Sex Hormone Binding Globulin (rl),1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
31900006,EAP,CPT® 81050,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc  Urine Volume Measurement (rl),1,39, 37.05 ,38.22, 37.05 , 37.83 , 37.05 ,Current Medicare Rates,37.83,37.44,Included in per diem,37.05,Included in ER Case rate,37.05,37.05, 38.22 ,35.1
31900018,EAP,CPT® 86635,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Antibody Coccidioides (rl),1,68.00, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30210671,EAP,CPT® 86658,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Antibody Enterovirus,1,54.00, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
31900019,EAP,CPT® 86788,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Antibody West Nile Virus Igm (rl),1,72.00, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30211128,EAP,CPT® 86060,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Antistreptolysin O Titer - Streptozyme Titer,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
31900015,EAP,CPT® 82570,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Assay Creatinine Other Source (rl),1,91.00, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
31900011,EAP,CPT® 82785,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Assay Of Gammaglobulin Ige (rl),1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
31900014,EAP,CPT® 82570,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Assay Of Urine Creatinine (rl),1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30112023,EAP,CPT® 82247,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Bilirubin Total,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
30610301,EAP,CPT® 87040,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Blood Culture For Bacteria,1,210.00, 199.50 ,205.8, 199.50 , 203.70 , 199.50 ,Current Medicare Rates,203.7,201.6,Included in per diem,199.5,Included in ER Case rate,199.5,199.5, 205.80 ,189
30210856,EAP,CPT® 86901,,0300 - LABORATORY - GENERAL CLASSIFICATION,"HC BLOOD TYPING, SEROLOGIC;   RH (D)",1,104.00, 98.80 ,101.92, 98.80 , 100.88 , 98.80 ,Current Medicare Rates,100.88,99.84,Included in per diem,98.8,Included in ER Case rate,98.8,98.8, 101.92 ,93.6
30011520,EAP,CPT® 89051,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Body Fluid Cell Count W/ Differential,1,112.00, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30011521,EAP,CPT® 89051,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Body Fluid Cell Count W/ Differential Csf,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
31010027,EAP,CPT® 85097,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Bone Marrow Interpretation,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30010011,EAP,CPT® 36416,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Capillary Blood Draw,1,31, 29.45 ,30.38, 29.45 , 30.07 , 29.45 ,Current Medicare Rates,30.07,29.76,Included in per diem,29.45,Included in ER Case rate,29.45,29.45, 30.38 ,27.9
30000004,EAP,89051,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30000008,EAP,89051,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30000010,EAP,89051,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30000011,EAP,89051,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT #,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30000003,EAP,89050,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CELL COUNT MISCELLANEOUS BODY FLUIDS #,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30000007,EAP,89050,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CELL COUNT MISCELLANEOUS BODY FLUIDS #,1,112.00, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30210636,EAP,CPT® 86631,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Chlamydia Antibody,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
30210646,EAP,CPT® 86632,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC Chlamydia igm antibody - Pneumoniae IGM 86632,1,42, 39.90 ,41.16, 39.90 , 40.74 , 39.90 ,Current Medicare Rates,40.74,40.32,Included in per diem,39.9,Included in ER Case rate,39.9,39.9, 41.16 ,37.8
30210986,EAP,CPT® 87496,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Cmv Pcr Qualitative,1,190, 180.50 ,186.2, 180.50 , 184.30 , 180.50 ,Current Medicare Rates,184.3,182.4,Included in per diem,180.5,Included in ER Case rate,180.5,180.5, 186.20 ,171
30210868,EAP,CPT® 86920,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Compatibility Each Unit Immediate Spin Technique,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30210867,EAP,CPT® 86920,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Compatibility Test Spin,1,147, 139.65 ,144.06, 139.65 , 142.59 , 139.65 ,Current Medicare Rates,142.59,141.12,Included in per diem,139.65,Included in ER Case rate,139.65,139.65, 144.06 ,132.3
30210416,EAP,CPT® 83520,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Complement/function Activity,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
31900013,EAP,CPT® 82570,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Creatinine Other Source (rl),1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30011585,EAP,CPT® 89060,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Crystal Exam,1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
30000006,EAP,89060,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID #,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30000006,EAP,89060,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID #,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30610359,EAP,CPT® 87077,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Culture Aerobic Identify - Aerobic Id,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30610321,EAP,CPT® 87070,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Culture Bacteria Other,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30610387,EAP,CPT® 87081,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Culture Screen Only,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30210911,EAP,CPT® 87140,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Culture Typing Immunfluorescent,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
30210995,EAP,CPT® 87798,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Detect Agent Nos-dna Amplified Probe,1,123, 116.85 ,120.54, 116.85 , 119.31 , 116.85 ,Current Medicare Rates,119.31,118.08,Included in per diem,116.85,Included in ER Case rate,116.85,116.85, 120.54 ,110.7
30211001,EAP,CPT® 87498,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Enterovirus Pcr,1,341, 323.95 ,334.18, 323.95 , 330.77 , 323.95 ,Current Medicare Rates,330.77,327.36,Included in per diem,323.95,Included in ER Case rate,323.95,323.95, 334.18 ,306.9
30011609,EAP,CPT® 89190,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Eosinophil Smear,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
30011616,EAP,CPT® 89125,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Fat Fecal Qualitative,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
30710011,EAP,CPT® 82705,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Fats/lipids Feces Qual,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
30010281,EAP,CPT® 89055,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Fecal Leukocytes,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,Included in per diem,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
30610304,EAP,CPT® 87045,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Feces Culture Bacteria,1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,Included in per diem,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30610436,EAP,CPT® 87106,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Fungi Identification Yeast,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30610421,EAP,CPT® 87102,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Fungus Isolation Culture - Yeast,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30014945,EAP,CPT® 82955,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc G6pd Quant Bld,1,70.00, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30014962,EAP,CPT® 82941,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Gastrin.,1,70.00, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30211006,EAP,CPT® 87591,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Gc By Pcr,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30015067,EAP,CPT® 85014,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hematocrit (hct),1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
30015068,EAP,CPT® 85013,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hematocrit Spun-misc Fluid,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
30010931,EAP,CPT® 86709,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hep A Antibody Igm,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
30010926,EAP,CPT® 86705,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hep B Core Antibody Igm,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30211012,EAP,CPT® 87521,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hep C Pcr (qual),1,170, 161.50 ,166.6, 161.50 , 164.90 , 161.50 ,Current Medicare Rates,164.9,163.2,Included in per diem,161.5,Included in ER Case rate,161.5,161.5, 166.60 ,153
30210798,EAP,CPT® 86803,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hepatitis C Ab Test,1,88, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
30211015,EAP,CPT® 87902,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hepatitis C Genotyping,1,650, 617.50 ,637, 617.50 , 630.50 , 617.50 ,Current Medicare Rates,630.5,624,Included in per diem,617.5,Included in ER Case rate,617.5,617.5, 637.00 ,585
30211017,EAP,CPT® 87529,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Herpes Simplex Pcr,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30211018,EAP,CPT® 87901,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hiv Genotyping,1,930, 883.50 ,911.4, 883.50 , 902.10 , 883.50 ,Current Medicare Rates,902.1,892.8,Included in per diem,883.5,Included in ER Case rate,883.5,883.5, 911.40 ,837
30211020,EAP,CPT® 87536,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hiv Ultra Sensitive Pcr,1,280, 266.00 ,274.4, 266.00 , 271.60 , 266.00 ,Current Medicare Rates,271.6,268.8,Included in per diem,266,Included in ER Case rate,266,266, 274.40 ,252
30210183,EAP,CPT® 87389,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hiv-1 Ag W/hiv-1 & Hiv-2 Ab,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30210719,EAP,CPT® 86703,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Hiv-1/hiv-2 Single Assay,1,133, 126.35 ,130.34, 126.35 , 129.01 , 126.35 ,Current Medicare Rates,129.01,127.68,Included in per diem,126.35,Included in ER Case rate,126.35,126.35, 130.34 ,119.7
30114312,EAP,87624,,0300 - LABORATORY - GENERAL CLASSIFICATION,HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES #,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30211511,EAP,CPT® 87502,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Influenza A-b Pcr,1,250, 237.50 ,245, 237.50 , 242.50 , 237.50 ,Current Medicare Rates,242.5,240,Included in per diem,237.5,Included in ER Case rate,237.5,237.5, 245.00 ,225
30015408,EAP,CPT® 85610,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Lupus Anticoag-pt,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30610504,EAP,CPT® 87186,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Microbe Susceptible Mic,1,140, 133.00 ,137.2, 133.00 , 135.80 , 133.00 ,Current Medicare Rates,135.8,134.4,Included in per diem,133,Included in ER Case rate,133,133, 137.20 ,126
30211050,EAP,CPT® 87641,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Mrsa Pcr,1,156, 148.20 ,152.88, 148.20 , 151.32 , 148.20 ,Current Medicare Rates,151.32,149.76,Included in per diem,148.2,Included in ER Case rate,148.2,148.2, 152.88 ,140.4
30210745,EAP,CPT® 86735,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Mumps Antibody,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
30610448,EAP,CPT® 87116,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Mycobacteria Culture - Afb Culture,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
30015575,EAP,CPT® 84030,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Ni Metabolic Screen,1,145, 137.75 ,142.1, 137.75 , 140.65 , 137.75 ,Current Medicare Rates,140.65,139.2,Included in per diem,137.75,Included in ER Case rate,137.75,137.75, 142.10 ,130.5
30015580,EAP,CPT® 83704,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Nmr-lipoprotein Par Qnt & Subclasses,1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
30211136,EAP,CPT® 86235,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Nuclear Antigen Antibody - Ena Smith,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30015715,EAP,CPT® 82962,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Poc Glucose,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
30015745,EAP,CPT® 82105,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Prenatal-alphafetoprotein,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30015746,EAP,CPT® 82677,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Prenatal-estriol,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30015747,EAP,CPT® 84702,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Prenatal-hcg Quantitative,1,179, 170.05 ,175.42, 170.05 , 173.63 , 170.05 ,Current Medicare Rates,173.63,171.84,Included in per diem,170.05,Included in ER Case rate,170.05,170.05, 175.42 ,161.1
30015755,EAP,CPT® 84206,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Proinsulin Peds,1,81, 76.95 ,79.38, 76.95 , 78.57 , 76.95 ,Current Medicare Rates,78.57,77.76,Included in per diem,76.95,Included in ER Case rate,76.95,76.95, 79.38 ,72.9
30015785,EAP,CPT® 84182,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Protein Western Blot Test Csf,1,378, 359.10 ,370.44, 359.10 , 366.66 , 359.10 ,Current Medicare Rates,366.66,362.88,Included in per diem,359.1,Included in ER Case rate,359.1,359.1, 370.44 ,340.2
30510032,EAP,CPT® 85610,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Prothrombin Time,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30013952,EAP,CPT® 85610,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Prothrombin Time 85610,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30015884,EAP,CPT® 85044,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Reticulocyte Count,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30210757,EAP,CPT® 86757,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Rickettsia Antibody,1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,Included in per diem,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30010004,EAP,CPT® 36415,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Routine Venipuncture,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30010009,EAP,CPT® 36415,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Routine Venipuncture - Collection Venous Bld,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30011752,EAP,CPT® 89321,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Semen Analysis  Sperm Detection And Motility,1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,Included in per diem,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30610420,EAP,CPT® 87101,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Skin Fungi Culture,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30610563,EAP,CPT® 87205,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Smear Gram Stain,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
31900000,EAP,CPT® 86360,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc T Cells Absolute Cd4&cd8 Count Ratio (rl),1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
31900003,EAP,CPT® 86359,,0300 - LABORATORY - GENERAL CLASSIFICATION,"Hc T Cells Total, Count (rl)",1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30210598,EAP,CPT® 86480,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Tb Test Cell Immun Measure,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
30610575,EAP,CPT® 87220,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Tissue Exam For Fungi,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30610479,EAP,CPT® 87176,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Tissue Homogenization Cultr - For Culture,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
30016070,EAP,CPT® 82657,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Tpmt Enzyme Activity,1,476, 452.20 ,466.48, 452.20 , 461.72 , 452.20 ,Current Medicare Rates,461.72,456.96,Included in per diem,452.2,Included in ER Case rate,452.2,452.2, 466.48 ,428.4
30013009,EAP,CPT® 81002,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Urinalysis Nonauto W/o Scope,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
31900005,EAP,CPT® 81050,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Urinalysis Volume Measure (rl),1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30610419,EAP,CPT® 87088,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Urine Bacteria Culture,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
30610417,EAP,CPT® 87086,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Urine Culture/colony Count,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
31900008,EAP,CPT® 81050,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Urine Volume Measurement Timed Each (rl),1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
31900007,EAP,CPT® 81050,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Vol Measurement Timed Collection (rl),1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
31900004,EAP,CPT® 81050,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Volume Measurement Timed Collection (rl),1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30010013,EAP,CPT® 36600,,0300 - LABORATORY - GENERAL CLASSIFICATION,Hc Withdrawal Of Arterial Blood,1,147, 139.65 ,144.06, 139.65 , 142.59 , 139.65 ,Current Medicare Rates,142.59,141.12,Included in per diem,139.65,Included in ER Case rate,139.65,139.65, 144.06 ,132.3
30114261,EAP,CPT® 82306,,0301 - LABORATORY - CHEMISTRY,Hc  25 Hydroxy Includes Fractions If Performed #,1,121, 114.95 ,118.58, 114.95 , 117.37 , 114.95 ,Current Medicare Rates,117.37,116.16,Included in per diem,114.95,Included in ER Case rate,114.95,114.95, 118.58 ,108.9
30110807,EAP,CPT® 80230,,0301 - LABORATORY - CHEMISTRY,HC  DRUG ASSAY INFLIXIMAB #,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30112786,EAP,CPT® 83491,,0301 - LABORATORY - CHEMISTRY,Hc 17 - Hydroxycorticosteroid,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30014006,EAP,CPT® 84143,,0301 - LABORATORY - CHEMISTRY,Hc 17-oh Pregnenolone Peds,1,165.9, 157.61 ,162.58, 157.61 , 160.92 , 157.61 ,Current Medicare Rates,160.92,159.26,Included in per diem,157.61,Included in ER Case rate,157.61,157.61, 162.58 ,149.31
30014009,EAP,CPT® 83497,,0301 - LABORATORY - CHEMISTRY,Hc 5-hiaa Quant Urine,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30014053,EAP,CPT® 82104,,0301 - LABORATORY - CHEMISTRY,Hc A1 Antritryp Phenotype,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,Included in ER Case rate,103.55,103.55, 106.82 ,98.1
30014072,EAP,CPT® 82010,,0301 - LABORATORY - CHEMISTRY,Hc Acetones Ketones Serum Quant,1,56, 53.20 ,54.88, 53.20 , 54.32 , 53.20 ,Current Medicare Rates,54.32,53.76,Included in per diem,53.2,Included in ER Case rate,53.2,53.2, 54.88 ,50.4
30112297,EAP,CPT® 83519,,0301 - LABORATORY - CHEMISTRY,Hc Acetylcholine Binding Ab,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30112151,EAP,CPT® 80400,,0301 - LABORATORY - CHEMISTRY,Hc Acth Stimulation Panel,1,238, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
30014113,EAP,CPT® 82105,,0301 - LABORATORY - CHEMISTRY,Hc Afp Tumor Marker,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30110482,EAP,CPT® 82040,,0301 - LABORATORY - CHEMISTRY,Hc Albumin Serum Plasma/whole Blood #,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
30014129,EAP,CPT® 82088,,0301 - LABORATORY - CHEMISTRY,Hc Aldosterone Bld,1,146, 138.70 ,143.08, 138.70 , 141.62 , 138.70 ,Current Medicare Rates,141.62,140.16,Included in per diem,138.7,Included in ER Case rate,138.7,138.7, 143.08 ,131.4
30110584,EAP,CPT® 82088,,0301 - LABORATORY - CHEMISTRY,Hc Aldosterone Plasma,1,146, 138.70 ,143.08, 138.70 , 141.62 , 138.70 ,Current Medicare Rates,141.62,140.16,Included in per diem,138.7,Included in ER Case rate,138.7,138.7, 143.08 ,131.4
30014138,EAP,CPT® 84075,,0301 - LABORATORY - CHEMISTRY,Hc Alkaline Phos,1,68.00, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30112845,EAP,CPT® 84080,,0301 - LABORATORY - CHEMISTRY,Hc Alkaline Phosphate Bone Specific,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30110638,EAP,CPT® 80323,,0301 - LABORATORY - CHEMISTRY,Hc Alkaloids Nos,1,162, 153.90 ,158.76, 153.90 , 157.14 , 153.90 ,Current Medicare Rates,157.14,155.52,Included in per diem,153.9,Included in ER Case rate,153.9,153.9, 158.76 ,145.8
30100117,EAP,80323,,0301 - LABORATORY - CHEMISTRY,HC ALKALOIDS NOT OTHERWISE SPECIFIED #,1,162, 153.90 ,158.76, 153.90 , 157.14 , 153.90 ,Current Medicare Rates,157.14,155.52,Included in per diem,153.9,Included in ER Case rate,153.9,153.9, 158.76 ,145.8
30100117,EAP,80323,,0301 - LABORATORY - CHEMISTRY,HC ALKALOIDS NOT OTHERWISE SPECIFIED #,1,162, 153.90 ,158.76, 153.90 , 157.14 , 153.90 ,Current Medicare Rates,157.14,155.52,Included in per diem,153.9,Included in ER Case rate,153.9,153.9, 158.76 ,145.8
30100122,EAP,80323,,0301 - LABORATORY - CHEMISTRY,HC ALKALOIDS NOT OTHERWISE SPECIFIED #,1,162, 153.90 ,158.76, 153.90 , 157.14 , 153.90 ,Current Medicare Rates,157.14,155.52,Included in per diem,153.9,Included in ER Case rate,153.9,153.9, 158.76 ,145.8
30100122,EAP,80323,,0301 - LABORATORY - CHEMISTRY,HC ALKALOIDS NOT OTHERWISE SPECIFIED #,1,162, 153.90 ,158.76, 153.90 , 157.14 , 153.90 ,Current Medicare Rates,157.14,155.52,Included in per diem,153.9,Included in ER Case rate,153.9,153.9, 158.76 ,145.8
30014151,EAP,CPT® 82103,,0301 - LABORATORY - CHEMISTRY,Hc Alpha1-antitrypsin,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30100127,EAP,82105,,0301 - LABORATORY - CHEMISTRY,HC ALPHA-FETOPROTEIN SERUM #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30014159,EAP,CPT® 82108,,0301 - LABORATORY - CHEMISTRY,Hc Aluminum Bld,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
30112867,EAP,CPT® 82131,,0301 - LABORATORY - CHEMISTRY,Hc Amino Acids Single Quant Each,1,225, 213.75 ,220.5, 213.75 , 218.25 , 213.75 ,Current Medicare Rates,218.25,216,Included in per diem,213.75,Included in ER Case rate,213.75,213.75, 220.50 ,202.5
30014174,EAP,CPT® 82139,,0301 - LABORATORY - CHEMISTRY,Hc Amino Acids: Plasma Quant,1,156, 148.20 ,152.88, 148.20 , 151.32 , 148.20 ,Current Medicare Rates,151.32,149.76,Included in per diem,148.2,Included in ER Case rate,148.2,148.2, 152.88 ,140.4
30013151,EAP,CPT® 82135,,0301 - LABORATORY - CHEMISTRY,Hc Aminolevulinic Acid Ur (arup),1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30112298,EAP,CPT® 82150,,0301 - LABORATORY - CHEMISTRY,Hc Amylase,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30112672,EAP,CPT® 82150,,0301 - LABORATORY - CHEMISTRY,Hc Amylase (urine),1,100.00, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30110644,EAP,CPT® 80329,,0301 - LABORATORY - CHEMISTRY,Hc Analgesics Non-opioid 1 Or 2,1,126.00, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30014232,EAP,CPT® 82542,,0301 - LABORATORY - CHEMISTRY,Hc Analyte By Gc/ms Or Hplc/ms Qu,1,94, 89.30 ,92.12, 89.30 , 91.18 , 89.30 ,Current Medicare Rates,91.18,90.24,Included in per diem,89.3,Included in ER Case rate,89.3,89.3, 92.12 ,84.6
30014233,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Anca-immuno Noninfect Agent,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30014234,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Anca-myeloperoxidase,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30112315,EAP,CPT® 82157,,0301 - LABORATORY - CHEMISTRY,Hc Androstenedione,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30014236,EAP,CPT® 82164,,0301 - LABORATORY - CHEMISTRY,Hc Angio Enzyme.,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30100132,EAP,82164,,0301 - LABORATORY - CHEMISTRY,HC ANGIOTENSIN I-CONVERTING ENZYME #,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30112483,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Anti-centromere Antibody,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30110647,EAP,CPT® 80332,,0301 - LABORATORY - CHEMISTRY,Hc Antidepressants Class 1 Or 2,1,816, 775.20 ,799.68, 775.20 , 791.52 , 775.20 ,Current Medicare Rates,791.52,783.36,Included in per diem,775.2,Included in ER Case rate,775.2,775.2, 799.68 ,734.4
30110654,EAP,CPT® 80339,,0301 - LABORATORY - CHEMISTRY,Hc Antiepileptics Nos 1-3,1,77.00, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30110657,EAP,CPT® 80342,,0301 - LABORATORY - CHEMISTRY,Hc Antipsychotics Nos 1-3,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30013115,EAP,CPT® 82542,,0301 - LABORATORY - CHEMISTRY,Hc Aripiprazole,1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
30112127,EAP,CPT® 83586,,0301 - LABORATORY - CHEMISTRY,Hc Assay 17- Ketosteroids,1,86.00, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
30112102,EAP,CPT® 82374,,0301 - LABORATORY - CHEMISTRY,Hc Assay Blood Carbon Dioxide,1,62.00, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30013039,EAP,CPT® 82375,,0301 - LABORATORY - CHEMISTRY,Hc Assay Carboxyhb Quant,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30112217,EAP,CPT® 82565,,0301 - LABORATORY - CHEMISTRY,Hc Assay Creatinine,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30112174,EAP,CPT® 80164,,0301 - LABORATORY - CHEMISTRY,Hc Assay Dipropylacetic Acid,1,169.00, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
30114183,EAP,CPT® 80200,,0301 - LABORATORY - CHEMISTRY,Hc Assay For Tobramycin,1,72.00, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30112080,EAP,CPT® 83003,,0301 - LABORATORY - CHEMISTRY,Hc Assay Growth Hormone (hgh),1,100.00, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30013061,EAP,CPT® 83698,,0301 - LABORATORY - CHEMISTRY,Hc Assay Lipoprotein Pla2,1,128, 121.60 ,125.44, 121.60 , 124.16 , 121.60 ,Current Medicare Rates,124.16,122.88,Included in per diem,121.6,Included in ER Case rate,121.6,121.6, 125.44 ,115.2
30013018,EAP,CPT® 82024,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Acth,1,175, 166.25 ,171.5, 166.25 , 169.75 , 166.25 ,Current Medicare Rates,169.75,168,Included in per diem,166.25,Included in ER Case rate,166.25,166.25, 171.50 ,157.5
30100049,EAP,82077,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF ALCOHOL (ETHANOL) SPEC XCP UR&BREATH IA #,1,153, 145.35 ,149.94, 145.35 , 148.41 , 145.35 ,Current Medicare Rates,148.41,146.88,Included in per diem,145.35,Included in ER Case rate,145.35,145.35, 149.94 ,137.7
30013019,EAP,CPT® 82085,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Aldolase,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,Included in per diem,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
30112152,EAP,CPT® 82088,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Aldosterone,1,146, 138.70 ,143.08, 138.70 , 141.62 , 138.70 ,Current Medicare Rates,141.62,140.16,Included in per diem,138.7,Included in ER Case rate,138.7,138.7, 143.08 ,131.4
30112403,EAP,CPT® 80150,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Amikacin,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30112108,EAP,CPT® 82140,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Ammonia,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30112316,EAP,CPT® 82172,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Apolipoprotein Each,1,88, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
30112018,EAP,CPT® 83721,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Blood Lipoprotein,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30110570,EAP,CPT® 84550,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Blood/uric Acid #,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
30112060,EAP,CPT® 82310,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Calcium,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30013004,EAP,CPT® 82390,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Ceruloplasmin,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30112160,EAP,CPT® 82550,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Ck (cpk),1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30013013,EAP,CPT® 84681,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of C-peptide,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
30112109,EAP,CPT® 80162,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Digoxin,1,149, 141.55 ,146.02, 141.55 , 144.53 , 141.55 ,Current Medicare Rates,144.53,143.04,Included in per diem,141.55,Included in ER Case rate,141.55,141.55, 146.02 ,134.1
30100050,EAP,82681,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF DIRECT MEASUREMENT FREE ESTRADIOL #,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30100136,EAP,82670,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF ESTRADIOL #,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30100136,EAP,82670,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF ESTRADIOL #,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30100138,EAP,82670,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF ESTRADIOL #,1,235, 223.25 ,230.3, 223.25 , 227.95 , 223.25 ,Current Medicare Rates,227.95,225.6,Included in per diem,223.25,Included in ER Case rate,223.25,223.25, 230.30 ,211.5
30100138,EAP,82670,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF ESTRADIOL #,1,235, 223.25 ,230.3, 223.25 , 227.95 , 223.25 ,Current Medicare Rates,227.95,225.6,Included in per diem,223.25,Included in ER Case rate,223.25,223.25, 230.30 ,211.5
30100128,EAP,82677,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF ESTRIOL #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30112220,EAP,CPT® 82672,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Estrogen,1,128, 121.60 ,125.44, 121.60 , 124.16 , 121.60 ,Current Medicare Rates,124.16,122.88,Included in per diem,121.6,Included in ER Case rate,121.6,121.6, 125.44 ,115.2
30112319,EAP,CPT® 82735,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Fluoride,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
30112074,EAP,CPT® 82747,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Folic Acid Rbc,1,108, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
30100133,EAP,82784,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100133,EAP,82784,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100134,EAP,82784,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100134,EAP,82784,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,1,85.00, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100135,EAP,82784,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100135,EAP,82784,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,1,85.00, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100130,EAP,82785,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGE #,1,54.00, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30100142,EAP,82785,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF GAMMAGLOBULIN IGE #,1,54.00, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30112164,EAP,CPT® 80170,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Gentamicin,1,187.00, 177.65 ,183.26, 177.65 , 181.39 , 177.65 ,Current Medicare Rates,181.39,179.52,Included in per diem,177.65,Included in ER Case rate,177.65,177.65, 183.26 ,168.3
30112198,EAP,CPT® 82943,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Glucagon,1,68.00, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30013038,EAP,CPT® 80173,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Haloperidol,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30112100,EAP,CPT® 83525,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Insulin,1,80.00, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30112112,EAP,CPT® 83540,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Iron,1,83.00, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
30112122,EAP,CPT® 83625,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Ldh Enzymes,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
30112116,EAP,CPT® 80178,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Lithium,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30013007,EAP,CPT® 83874,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Myoglobin,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
30013102,EAP,CPT® 84591,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Nos Vitamin,1,171, 162.45 ,167.58, 162.45 , 165.87 , 162.45 ,Current Medicare Rates,165.87,164.16,Included in per diem,162.45,Included in ER Case rate,162.45,162.45, 167.58 ,153.9
30110189,EAP,CPT® 83970,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Parathormone #,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30110510,EAP,CPT® 80184,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Phenobarbital Level,1,130.00, 123.50 ,127.4, 123.50 , 126.10 , 123.50 ,Current Medicare Rates,126.1,124.8,Included in per diem,123.5,Included in ER Case rate,123.5,123.5, 127.40 ,117
30112088,EAP,CPT® 80186,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Phenytoin Free,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
30112228,EAP,CPT® 80185,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Phenytoin Total,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,Included in per diem,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
30017090,EAP,CPT® 82759,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Rbc Galactokinase,1,93, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,Included in per diem,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
30112003,EAP,CPT® 82040,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Serum Albumin,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30112019,EAP,CPT® 80197,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Tacrolimus,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30110193,EAP,CPT® 84402,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Testosterone Free #,1,60.00, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30112071,EAP,CPT® 80198,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Theophylline,1,62.00, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30112094,EAP,CPT® 80201,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Topiramate,1,72.00, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30100123,EAP,84481,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF TRIIODOTHYRONINE T3 FREE #,1,226, 214.70 ,221.48, 214.70 , 219.22 , 214.70 ,Current Medicare Rates,219.22,216.96,Included in per diem,214.7,Included in ER Case rate,214.7,214.7, 221.48 ,203.4
30100125,EAP,84481,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF TRIIODOTHYRONINE T3 FREE #,1,125.00, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30100119,EAP,84480,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 #,1,106.00, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
30100124,EAP,84480,,0301 - LABORATORY - CHEMISTRY,HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 #,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,Included in per diem,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
30112036,EAP,CPT® 84585,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Urine Vma,1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
30110602,EAP,CPT® 80202,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Vancomycin,1,186, 176.70 ,182.28, 176.70 , 180.42 , 176.70 ,Current Medicare Rates,180.42,178.56,Included in per diem,176.7,Included in ER Case rate,176.7,176.7, 182.28 ,167.4
30112098,EAP,CPT® 84588,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Vasopressin,1,148, 140.60 ,145.04, 140.60 , 143.56 , 140.60 ,Current Medicare Rates,143.56,142.08,Included in per diem,140.6,Included in ER Case rate,140.6,140.6, 145.04 ,133.2
30112134,EAP,CPT® 84586,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Vip,1,139, 132.05 ,136.22, 132.05 , 134.83 , 132.05 ,Current Medicare Rates,134.83,133.44,Included in per diem,132.05,Included in ER Case rate,132.05,132.05, 136.22 ,125.1
30112039,EAP,CPT® 84590,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Vitamin A,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
30112185,EAP,CPT® 84597,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Vitamin K,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
31900057,EAP,CPT® 84630,,0301 - LABORATORY - CHEMISTRY,Hc Assay Of Zinc (rl),1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30112233,EAP,CPT® 82438,,0301 - LABORATORY - CHEMISTRY,Hc Assay Other Fluid Chlorides,1,18, 17.10 ,17.64, 17.10 , 17.46 , 17.10 ,Current Medicare Rates,17.46,17.28,Included in per diem,17.1,Included in ER Case rate,17.1,17.1, 17.64 ,16.2
30112107,EAP,CPT® 84100,,0301 - LABORATORY - CHEMISTRY,Hc Assay Phosphorus,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30112278,EAP,CPT® 82274,,0301 - LABORATORY - CHEMISTRY,Hc Assay Test For Blood Fecal,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
30014358,EAP,CPT® 84466,,0301 - LABORATORY - CHEMISTRY,Hc Assay Transferrin,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30014366,EAP,CPT® 82608,,0301 - LABORATORY - CHEMISTRY,Hc B-12 Binding Capacity Cyanobobalamin,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30112061,EAP,CPT® 80048,,0301 - LABORATORY - CHEMISTRY,Hc Basic Metabolic Panel,1,140, 133.00 ,137.2, 133.00 , 135.80 , 133.00 ,Current Medicare Rates,135.8,134.4,Included in per diem,133,Included in ER Case rate,133,133, 137.20 ,126
30112352,EAP,CPT® 82232,,0301 - LABORATORY - CHEMISTRY,Hc Beta 2 Microglobulin,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30113011,EAP,CPT® 82010,,0301 - LABORATORY - CHEMISTRY,Hc Beta Hydroxybutyrate,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30014414,EAP,CPT® 82239,,0301 - LABORATORY - CHEMISTRY,Hc Biles Acids Total,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30112043,EAP,CPT® 82248,,0301 - LABORATORY - CHEMISTRY,Hc Bilirubin Direct,1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
30011424,EAP,CPT® 88720,,0301 - LABORATORY - CHEMISTRY,Hc Bilirubin Total Transcutaneous,1,23, 21.85 ,22.54, 21.85 , 22.31 , 21.85 ,Current Medicare Rates,22.31,22.08,Included in per diem,21.85,Included in ER Case rate,21.85,21.85, 22.54 ,20.7
30014441,EAP,CPT® 84403,,0301 - LABORATORY - CHEMISTRY,Hc Bio-t-testosterone Total,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30112106,EAP,CPT® 82746,,0301 - LABORATORY - CHEMISTRY,Hc Blood Folic Acid Serum,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30014449,EAP,CPT® 82803,,0301 - LABORATORY - CHEMISTRY,Hc Blood Gas,1,262, 248.90 ,256.76, 248.90 , 254.14 , 248.90 ,Current Medicare Rates,254.14,251.52,Included in per diem,248.9,Included in ER Case rate,248.9,248.9, 256.76 ,235.8
30112126,EAP,CPT® 82800,,0301 - LABORATORY - CHEMISTRY,Hc Blood Ph,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
31900054,EAP,81162,,0301 - LABORATORY - CHEMISTRY,HC BRCA1&BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS (RL),1,4477," 4,253.15 ",4387.46," 4,253.15 "," 4,342.69 "," 4,253.15 ",Current Medicare Rates,4342.69,4297.92,Included in per diem,4253.15,Included in ER Case rate,4253.15,4253.15," 4,387.46 ",4029.3
30014459,EAP,CPT® 84520,,0301 - LABORATORY - CHEMISTRY,Hc Bun,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30014462,EAP,CPT® 84681,,0301 - LABORATORY - CHEMISTRY,Hc C Peptide,1,160, 152.00 ,156.8, 152.00 , 155.20 , 152.00 ,Current Medicare Rates,155.2,153.6,Included in per diem,152,Included in ER Case rate,152,152, 156.80 ,144
30014480,EAP,CPT® 82308,,0301 - LABORATORY - CHEMISTRY,Hc Calcitonin Bld,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
30014481,EAP,CPT® 82330,,0301 - LABORATORY - CHEMISTRY,Hc Calcium Ionized,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30014484,EAP,CPT® 82340,,0301 - LABORATORY - CHEMISTRY,HC CALCIUM QUANT URINE,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
30013847,EAP,CPT® 82310,,0301 - LABORATORY - CHEMISTRY,Hc Calcium Serum,1,67, 63.65 ,65.66, 63.65 , 64.99 , 63.65 ,Current Medicare Rates,64.99,64.32,Included in per diem,63.65,Included in ER Case rate,63.65,63.65, 65.66 ,60.3
30113075,EAP,CPT® 82340,,0301 - LABORATORY - CHEMISTRY,Hc Calcium Urine Random,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
30112138,EAP,CPT® 82365,,0301 - LABORATORY - CHEMISTRY,Hc Calculus Spectroscopy,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30013774,EAP,CPT® 83993,,0301 - LABORATORY - CHEMISTRY,Hc Calprotectin Fecal,1,322, 305.90 ,315.56, 305.90 , 312.34 , 305.90 ,Current Medicare Rates,312.34,309.12,Included in per diem,305.9,Included in ER Case rate,305.9,305.9, 315.56 ,289.8
30112424,EAP,CPT® 82542,,0301 - LABORATORY - CHEMISTRY,Hc Cannabinoid Ur Gc/ms (arup),1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
30110664,EAP,CPT® 80349,,0301 - LABORATORY - CHEMISTRY,Hc Cannabinoids Natural,1,87, 82.65 ,85.26, 82.65 , 84.39 , 82.65 ,Current Medicare Rates,84.39,83.52,Included in per diem,82.65,Included in ER Case rate,82.65,82.65, 85.26 ,78.3
30112046,EAP,CPT® 80156,,0301 - LABORATORY - CHEMISTRY,Hc Carbamazepine-tegretol,1,171, 162.45 ,167.58, 162.45 , 165.87 , 162.45 ,Current Medicare Rates,165.87,164.16,Included in per diem,162.45,Included in ER Case rate,162.45,162.45, 167.58 ,153.9
30014495,EAP,CPT® 82374,,0301 - LABORATORY - CHEMISTRY,Hc Carbon Dioxide Content,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30014496,EAP,CPT® 82375,,0301 - LABORATORY - CHEMISTRY,Hc Carboxyhemoglobin Quantitative,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30113956,EAP,CPT® 82384,,0301 - LABORATORY - CHEMISTRY,Hc Catecholamines Fractionated #,1,150, 142.50 ,147, 142.50 , 145.50 , 142.50 ,Current Medicare Rates,145.5,144,Included in per diem,142.5,Included in ER Case rate,142.5,142.5, 147.00 ,135
30014500,EAP,CPT® 82384,,0301 - LABORATORY - CHEMISTRY,Hc Catecholamines Fractionated Pl,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30112353,EAP,CPT® 82384,,0301 - LABORATORY - CHEMISTRY,Hc Catecholamines Fractionated Ur,1,139, 132.05 ,136.22, 132.05 , 134.83 , 132.05 ,Current Medicare Rates,134.83,133.44,Included in per diem,132.05,Included in ER Case rate,132.05,132.05, 136.22 ,125.1
30110300,EAP,CPT® 81403,,0301 - LABORATORY - CHEMISTRY,Hc Cc Msc Molecular Pathology Procedure  Level 4,1,676, 642.20 ,662.48, 642.20 , 655.72 , 642.20 ,Current Medicare Rates,655.72,648.96,Included in per diem,642.2,Included in ER Case rate,642.2,642.2, 662.48 ,608.4
30110385,EAP,CPT® 81406,,0301 - LABORATORY - CHEMISTRY,"Hc Cc Msc Molecular Pathology Procedure, Level 7",1,1032, 980.40 ,1011.36, 980.40 ," 1,001.04 ", 980.40 ,Current Medicare Rates,1001.04,990.72,Included in per diem,980.4,Included in ER Case rate,980.4,980.4," 1,011.36 ",928.8
30014520,EAP,CPT® 82378,,0301 - LABORATORY - CHEMISTRY,Hc Cea-carcinoembryonic Antigen,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30014525,EAP,CPT® 83520,,0301 - LABORATORY - CHEMISTRY,Hc Centromere Antibody,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30014527,EAP,CPT® 82390,,0301 - LABORATORY - CHEMISTRY,Hc Ceruloplasmin.,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30014538,EAP,CPT® 82397,,0301 - LABORATORY - CHEMISTRY,Hc Chemiluminescent Assay,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30112700,EAP,CPT® 82436,,0301 - LABORATORY - CHEMISTRY,Hc Chloride - 24 Hr Urine,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30014542,EAP,CPT® 82435,,0301 - LABORATORY - CHEMISTRY,Hc Chloride Blood,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
30014544,EAP,CPT® 82436,,0301 - LABORATORY - CHEMISTRY,Hc Chloride Urine,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30112251,EAP,CPT® 82465,,0301 - LABORATORY - CHEMISTRY,Hc Cholesterol,1,52, 49.40 ,50.96, 49.40 , 50.44 , 49.40 ,Current Medicare Rates,50.44,49.92,Included in per diem,49.4,Included in ER Case rate,49.4,49.4, 50.96 ,46.8
30113110,EAP,CPT® 84311,,0301 - LABORATORY - CHEMISTRY,"Hc Cholesterol, Fluid",1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30112030,EAP,CPT® 84703,,0301 - LABORATORY - CHEMISTRY,Hc Chorionic Gonadotropin Qual,1,116, 110.20 ,113.68, 110.20 , 112.52 , 110.20 ,Current Medicare Rates,112.52,111.36,Included in per diem,110.2,Included in ER Case rate,110.2,110.2, 113.68 ,104.4
30016280,EAP,CPT® 82495,,0301 - LABORATORY - CHEMISTRY,Hc Chromium Serum,1,116, 110.20 ,113.68, 110.20 , 112.52 , 110.20 ,Current Medicare Rates,112.52,111.36,Included in per diem,110.2,Included in ER Case rate,110.2,110.2, 113.68 ,104.4
30014564,EAP,CPT® 82507,,0301 - LABORATORY - CHEMISTRY,Hc Citrate Quant Urine,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30014566,EAP,CPT® 82550,,0301 - LABORATORY - CHEMISTRY,Hc Ck Total,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30014567,EAP,CPT® 82553,,0301 - LABORATORY - CHEMISTRY,Hc Ck-mb,1,175, 166.25 ,171.5, 166.25 , 169.75 , 166.25 ,Current Medicare Rates,169.75,168,Included in per diem,166.25,Included in ER Case rate,166.25,166.25, 171.50 ,157.5
30016272,EAP,CPT® 83018,,0301 - LABORATORY - CHEMISTRY,Hc Cobalt Serum,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30112062,EAP,CPT® 80053,,0301 - LABORATORY - CHEMISTRY,Hc Comprehen Metabolic Panel,1,165, 156.75 ,161.7, 156.75 , 160.05 , 156.75 ,Current Medicare Rates,160.05,158.4,Included in per diem,156.75,Included in ER Case rate,156.75,156.75, 161.70 ,148.5
30014603,EAP,CPT® 82525,,0301 - LABORATORY - CHEMISTRY,Hc Copper.,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30014605,EAP,CPT® 82533,,0301 - LABORATORY - CHEMISTRY,Hc Cortisol,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30112054,EAP,CPT® 82530,,0301 - LABORATORY - CHEMISTRY,Hc Cortisol Free,1,108, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
30014608,EAP,CPT® 82530,,0301 - LABORATORY - CHEMISTRY,Hc Cortisol Free Urine 24 Hr,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30112705,EAP,CPT® 82570,,0301 - LABORATORY - CHEMISTRY,Hc Creatinine (24hr Ur),1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30112707,EAP,CPT® 82570,,0301 - LABORATORY - CHEMISTRY,Hc Creatinine (random Ur),1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30100021,EAP,CPT® 82565,,0301 - LABORATORY - CHEMISTRY,HC CREATININE BLOOD #,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30014631,EAP,CPT® 82575,,0301 - LABORATORY - CHEMISTRY,Hc Creatinine Clearance-serum + Urine,1,170, 161.50 ,166.6, 161.50 , 164.90 , 161.50 ,Current Medicare Rates,164.9,163.2,Included in per diem,161.5,Included in ER Case rate,161.5,161.5, 166.60 ,153
30112358,EAP,CPT® 82570,,0301 - LABORATORY - CHEMISTRY,Hc Creatinine Other Source,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
30016275,EAP,CPT® 82570,,0301 - LABORATORY - CHEMISTRY,Hc Creatinine Urine,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30014642,EAP,CPT® 82595,,0301 - LABORATORY - CHEMISTRY,Hc Cryoglobulin Serum,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
30110148,EAP,CPT® G0480,,0301 - LABORATORY - CHEMISTRY,Hc Definitive Drugs Exclude Ia And Enzyme Methods  Per Day 1-7 Drugs,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30014683,EAP,CPT® 82626,,0301 - LABORATORY - CHEMISTRY,Hc Dhea Quant,1,148, 140.60 ,145.04, 140.60 , 143.56 , 140.60 ,Current Medicare Rates,143.56,142.08,Included in per diem,140.6,Included in ER Case rate,140.6,140.6, 145.04 ,133.2
30014685,EAP,CPT® 82627,,0301 - LABORATORY - CHEMISTRY,Hc Dhea Sulfate.,1,196, 186.20 ,192.08, 186.20 , 190.12 , 186.20 ,Current Medicare Rates,190.12,188.16,Included in per diem,186.2,Included in ER Case rate,186.2,186.2, 192.08 ,176.4
30100039,EAP,80143,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY ACETAMINOPHEN #,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30100040,EAP,80151,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY AMIODARONE #,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30100041,EAP,80161,,0301 - LABORATORY - CHEMISTRY,"HC DRUG ASSAY CARBAMAZEPINE -10,11-EPOXIDE #",1,156, 148.20 ,152.88, 148.20 , 151.32 , 148.20 ,Current Medicare Rates,151.32,149.76,Included in per diem,148.2,Included in ER Case rate,148.2,148.2, 152.88 ,140.4
30100042,EAP,80167,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY FELBAMATE #,1,172, 163.40 ,168.56, 163.40 , 166.84 , 163.40 ,Current Medicare Rates,166.84,165.12,Included in per diem,163.4,Included in ER Case rate,163.4,163.4, 168.56 ,154.8
30100044,EAP,80181,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY FLECAINIDE #,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30100045,EAP,80189,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY ITRACONZAOLE #,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
30110241,EAP,CPT® 80235,,0301 - LABORATORY - CHEMISTRY,Hc Drug Assay Lacosamide Cdm,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
30100046,EAP,80193,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY LEFLUNOMIDE #,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
30100047,EAP,80204,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY METHOTREXATE #,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
30100048,EAP,80210,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY RUFINAMIDE,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
30100043,EAP,80179,,0301 - LABORATORY - CHEMISTRY,HC DRUG ASSAY SALICYLATE #,1,121, 114.95 ,118.58, 114.95 , 117.37 , 114.95 ,Current Medicare Rates,117.37,116.16,Included in per diem,114.95,Included in ER Case rate,114.95,114.95, 118.58 ,108.9
30110131,EAP,CPT® 80175,,0301 - LABORATORY - CHEMISTRY,Hc Drug Screen Quan Lamotrigine,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30110128,EAP,CPT® 80159,,0301 - LABORATORY - CHEMISTRY,Hc Drug Screen Quant Clozapine,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30110130,EAP,CPT® 80171,,0301 - LABORATORY - CHEMISTRY,Hc Drug Screen Quant Gabapentin Whole Blood Serum Plasma,1,73, 69.35 ,71.54, 69.35 , 70.81 , 69.35 ,Current Medicare Rates,70.81,70.08,Included in per diem,69.35,Included in ER Case rate,69.35,69.35, 71.54 ,65.7
30110136,EAP,CPT® 80203,,0301 - LABORATORY - CHEMISTRY,Hc Drug Screen Quant Zonisamide,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
30110635,EAP,CPT® 80320,,0301 - LABORATORY - CHEMISTRY,Hc Drug Screen Quantalcohols,1,165, 156.75 ,161.7, 156.75 , 160.05 , 156.75 ,Current Medicare Rates,160.05,158.4,Included in per diem,156.75,Included in ER Case rate,156.75,156.75, 161.70 ,148.5
30114343,EAP,CPT® 80355,,0301 - LABORATORY - CHEMISTRY,Hc Drug Screening Gabapentin Non-blood,1,149, 141.55 ,146.02, 141.55 , 144.53 , 141.55 ,Current Medicare Rates,144.53,143.04,Included in per diem,141.55,Included in ER Case rate,141.55,141.55, 146.02 ,134.1
30110552,EAP,80373,,0301 - LABORATORY - CHEMISTRY,HC DRUG SCREENING TRAMADOL,1,180, 171.00 ,176.4, 171.00 , 174.60 , 171.00 ,Current Medicare Rates,174.6,172.8,Included in per diem,171,Included in ER Case rate,171,171, 176.40 ,162
30110132,EAP,CPT® 80177,,0301 - LABORATORY - CHEMISTRY,Hc Drug Scrn Quan Levetiracetam,1,160, 152.00 ,156.8, 152.00 , 155.20 , 152.00 ,Current Medicare Rates,155.2,153.6,Included in per diem,152,Included in ER Case rate,152,152, 156.80 ,144
30110134,EAP,CPT® 80183,,0301 - LABORATORY - CHEMISTRY,Hc Drug Scrn Quant Oxcarbazepin,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30114382,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Acetaminophen, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30114383,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Alcohol, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30114384,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Amphetamines, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114385,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Barbiturates, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114386,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Benzodiazepine, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114388,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Cocaine, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114389,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Cordstat, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30114390,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Ethylglcuronide, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30114391,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Meconium, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114392,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Meth, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114393,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Methadone, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114394,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Nicotine, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30114395,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Nonchromo Drugs Of Abuse 12, Per Dos",1,281, 266.95 ,275.38, 266.95 , 272.57 , 266.95 ,Current Medicare Rates,272.57,269.76,Included in per diem,266.95,Included in ER Case rate,266.95,266.95, 275.38 ,252.9
30114396,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Nonchromo Drugs Of Abuse 4, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114397,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Nonchromo Drugs Of Abuse 6, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114398,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Nonchromo Drugs Of Abuse 8, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114399,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Opiates Urine, Per Dos",1,282, 267.90 ,276.36, 267.90 , 273.54 , 267.90 ,Current Medicare Rates,273.54,270.72,Included in per diem,267.9,Included in ER Case rate,267.9,267.9, 276.36 ,253.8
30114400,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Opiates, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114401,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Pcp, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114387,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114381,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30114402,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Propox, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114403,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Salicylate, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30114404,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Thc Urine, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114405,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Thc, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114406,EAP,CPT® 80307,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Chem Anlyzr, Tricyclics, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114379,EAP,CPT® 80305,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Direct Opt Obs, Per Dos",1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30114380,EAP,CPT® 80306,,0301 - LABORATORY - CHEMISTRY,"Hc Drug Test Prsmv Optical Instrmnt, Per Dos",1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30112031,EAP,CPT® 80051,,0301 - LABORATORY - CHEMISTRY,Hc Electrolyte Panel,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30113284,EAP,CPT® 84166,,0301 - LABORATORY - CHEMISTRY,Hc Electrophoresis Urine Random,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30014775,EAP,CPT® 84166,,0301 - LABORATORY - CHEMISTRY,Hc Elp Ur-protein Elp Urine,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30014776,EAP,CPT® 84156,,0301 - LABORATORY - CHEMISTRY,Hc Elp Ur-protein Total Urine,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30014795,EAP,CPT® 82668,,0301 - LABORATORY - CHEMISTRY,Hc Erythropoietin Bld,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30014796,EAP,CPT® 82670,,0301 - LABORATORY - CHEMISTRY,Hc Estradiol,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30014801,EAP,CPT® 82677,,0301 - LABORATORY - CHEMISTRY,Hc Estriol Level,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30012036,EAP,CPT® 82671,,0301 - LABORATORY - CHEMISTRY,Hc Estrogens Fractionated,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30112650,EAP,CPT® 82679,,0301 - LABORATORY - CHEMISTRY,Hc Estrone,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30014877,EAP,CPT® 82270,,0301 - LABORATORY - CHEMISTRY,Hc Fecal Occult Bld (1-3 Samples),1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30013881,EAP,CPT® 82728,,0301 - LABORATORY - CHEMISTRY,Hc Ferritin,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30014881,EAP,CPT® 82731,,0301 - LABORATORY - CHEMISTRY,Hc Fetal Fibronectin,1,341, 323.95 ,334.18, 323.95 , 330.77 , 323.95 ,Current Medicare Rates,330.77,327.36,Included in per diem,323.95,Included in ER Case rate,323.95,323.95, 334.18 ,306.9
30112710,EAP,CPT® 83030,,0301 - LABORATORY - CHEMISTRY,Hc Fetal Hemoglobin Chemical,1,41, 38.95 ,40.18, 38.95 , 39.77 , 38.95 ,Current Medicare Rates,39.77,39.36,Included in per diem,38.95,Included in ER Case rate,38.95,38.95, 40.18 ,36.9
30014892,EAP,CPT® 80197,,0301 - LABORATORY - CHEMISTRY,Hc Fk506 - Prograf,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30014898,EAP,CPT® 82746,,0301 - LABORATORY - CHEMISTRY,Hc Folate,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30014932,EAP,CPT® 84481,,0301 - LABORATORY - CHEMISTRY,Hc Free T-3 Icma,1,226, 214.70 ,221.48, 214.70 , 219.22 , 214.70 ,Current Medicare Rates,219.22,216.96,Included in per diem,214.7,Included in ER Case rate,214.7,214.7, 221.48 ,203.4
30014933,EAP,CPT® 84439,,0301 - LABORATORY - CHEMISTRY,Hc Free T4,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30014937,EAP,CPT® 83001,,0301 - LABORATORY - CHEMISTRY,Hc Fsh,1,177, 168.15 ,173.46, 168.15 , 171.69 , 168.15 ,Current Medicare Rates,171.69,169.92,Included in per diem,168.15,Included in ER Case rate,168.15,168.15, 173.46 ,159.3
30014949,EAP,CPT® 82977,,0301 - LABORATORY - CHEMISTRY,Hc Gamma Gt Total,1,88, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
30014950,EAP,CPT® 82784,,0301 - LABORATORY - CHEMISTRY,Hc Gammaglobulin Iga Igd Igg Igm Each,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30014951,EAP,CPT® 82784,,0301 - LABORATORY - CHEMISTRY,Hc Gammaglobulin Immunoglobulin Group,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30013040,EAP,CPT® 80050,,0301 - LABORATORY - CHEMISTRY,Hc General Health Panel,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
30013189,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Gliadin Ab Igg,1,97, 92.15 ,95.06, 92.15 , 94.09 , 92.15 ,Current Medicare Rates,94.09,93.12,Included in per diem,92.15,Included in ER Case rate,92.15,92.15, 95.06 ,87.3
30014972,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Gliadin Ab Panel Immunoassay Analyte Other Than Infectious Agent Antibody,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30112504,EAP,CPT® 82945,,0301 - LABORATORY - CHEMISTRY,Hc Glucose (urine 24 Hr),1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30014981,EAP,CPT® 82945,,0301 - LABORATORY - CHEMISTRY,Hc Glucose Body Fluid Other Than Blood,1,79, 75.05 ,77.42, 75.05 , 76.63 , 75.05 ,Current Medicare Rates,76.63,75.84,Included in per diem,75.05,Included in ER Case rate,75.05,75.05, 77.42 ,71.1
30014980,EAP,CPT® 82950,,0301 - LABORATORY - CHEMISTRY,Hc Glucose Post Glucose Dose (includes Glucose),1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30014986,EAP,CPT® 82947,,0301 - LABORATORY - CHEMISTRY,Hc Glucose Quantitative Blood (except Reagent Strip),1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30014990,EAP,CPT® 82951,,0301 - LABORATORY - CHEMISTRY,HC GLUCOSE TOLERANCE TEST (GTT) 3,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30112719,EAP,CPT® 82951,,0301 - LABORATORY - CHEMISTRY,Hc Glucose Tolerance(3 Spec),1,181, 171.95 ,177.38, 171.95 , 175.57 , 171.95 ,Current Medicare Rates,175.57,173.76,Included in per diem,171.95,Included in ER Case rate,171.95,171.95, 177.38 ,162.9
30113387,EAP,CPT® 82945,,0301 - LABORATORY - CHEMISTRY,Hc Glucose Urine,1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
30015020,EAP,CPT® 83036,,0301 - LABORATORY - CHEMISTRY,Hc Glycosylated Hemoglobin,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
30112066,EAP,CPT® 83036,,0301 - LABORATORY - CHEMISTRY,Hc Glycosylated Hemoglobin Test,1,93, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,Included in per diem,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
30015025,EAP,CPT® 84702,,0301 - LABORATORY - CHEMISTRY,Hc Gonadotropin Chorionic (hcg) Quantitative,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30100126,EAP,84702,,0301 - LABORATORY - CHEMISTRY,HC GONADOTROPIN CHORIONIC QUANTITATIVE #,1,179, 170.05 ,175.42, 170.05 , 173.63 , 170.05 ,Current Medicare Rates,173.63,171.84,Included in per diem,170.05,Included in ER Case rate,170.05,170.05, 175.42 ,161.1
30100126,EAP,84702,,0301 - LABORATORY - CHEMISTRY,HC GONADOTROPIN CHORIONIC QUANTITATIVE #,1,179, 170.05 ,175.42, 170.05 , 173.63 , 170.05 ,Current Medicare Rates,173.63,171.84,Included in per diem,170.05,Included in ER Case rate,170.05,170.05, 175.42 ,161.1
30100129,EAP,84702,,0301 - LABORATORY - CHEMISTRY,HC GONADOTROPIN CHORIONIC QUANTITATIVE #,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30100129,EAP,84702,,0301 - LABORATORY - CHEMISTRY,HC GONADOTROPIN CHORIONIC QUANTITATIVE #,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30100137,EAP,84702,,0301 - LABORATORY - CHEMISTRY,HC GONADOTROPIN CHORIONIC QUANTITATIVE #,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30100137,EAP,84702,,0301 - LABORATORY - CHEMISTRY,HC GONADOTROPIN CHORIONIC QUANTITATIVE #,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30112068,EAP,CPT® 82952,,0301 - LABORATORY - CHEMISTRY,Hc Gtt-added Samples,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
30015036,EAP,CPT® 83010,,0301 - LABORATORY - CHEMISTRY,Hc Haptoglobin.,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30015043,EAP,CPT® 84703,,0301 - LABORATORY - CHEMISTRY,Hc Hcg Screen (serum),1,139, 132.05 ,136.22, 132.05 , 134.83 , 132.05 ,Current Medicare Rates,134.83,133.44,Included in per diem,132.05,Included in ER Case rate,132.05,132.05, 136.22 ,125.1
30015065,EAP,CPT® 83013,,0301 - LABORATORY - CHEMISTRY,Hc Helico Pylori Breath Test,1,288, 273.60 ,282.24, 273.60 , 279.36 , 273.60 ,Current Medicare Rates,279.36,276.48,Included in per diem,273.6,Included in ER Case rate,273.6,273.6, 282.24 ,259.2
30112142,EAP,CPT® 83021,,0301 - LABORATORY - CHEMISTRY,Hc Hemoglobin Chromotography,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30013048,EAP,CPT® 83020,,0301 - LABORATORY - CHEMISTRY,Hc Hemoglobin Electrophoresis,1,39, 37.05 ,38.22, 37.05 , 37.83 , 37.05 ,Current Medicare Rates,37.83,37.44,Included in per diem,37.05,Included in ER Case rate,37.05,37.05, 38.22 ,35.1
30113422,EAP,CPT® 83021,,0301 - LABORATORY - CHEMISTRY,Hc Hemoglobin Fraction & Quant,1,67, 63.65 ,65.66, 63.65 , 64.99 , 63.65 ,Current Medicare Rates,64.99,64.32,Included in per diem,63.65,Included in ER Case rate,63.65,63.65, 65.66 ,60.3
30015078,EAP,CPT® 83050,,0301 - LABORATORY - CHEMISTRY,Hc Hemoglobin Methemoglobin Quantitative,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
30112103,EAP,CPT® 80076,,0301 - LABORATORY - CHEMISTRY,Hc Hepatic Function Panel,1,148, 140.60 ,145.04, 140.60 , 143.56 , 140.60 ,Current Medicare Rates,143.56,142.08,Included in per diem,140.6,Included in ER Case rate,140.6,140.6, 145.04 ,133.2
30112029,EAP,CPT® 80074,,0301 - LABORATORY - CHEMISTRY,Hc Hepatitis Acute Panel,1,190, 180.50 ,186.2, 180.50 , 184.30 , 180.50 ,Current Medicare Rates,184.3,182.4,Included in per diem,180.5,Included in ER Case rate,180.5,180.5, 186.20 ,171
30015152,EAP,CPT® 83051,,0301 - LABORATORY - CHEMISTRY,Hc Hgb Plasma,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
30112330,EAP,CPT® 83088,,0301 - LABORATORY - CHEMISTRY,Hc Histamine,1,132, 125.40 ,129.36, 125.40 , 128.04 , 125.40 ,Current Medicare Rates,128.04,126.72,Included in per diem,125.4,Included in ER Case rate,125.4,125.4, 129.36 ,118.8
30113450,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Histone Ab Igg,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30112310,EAP,CPT® 83090,,0301 - LABORATORY - CHEMISTRY,Hc Homocysteine,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30015183,EAP,CPT® 83150,,0301 - LABORATORY - CHEMISTRY,Hc Homovanillic Acid (hva),1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
30110054,EAP,87533,,0301 - LABORATORY - CHEMISTRY,HC HV6 DNA QUANTIFICATION,1,146, 138.70 ,143.08, 138.70 , 141.62 , 138.70 ,Current Medicare Rates,141.62,140.16,Included in per diem,138.7,Included in ER Case rate,138.7,138.7, 143.08 ,131.4
30015188,EAP,CPT® 82175,,0301 - LABORATORY - CHEMISTRY,Hc Hvy Met Bld - Arsenic,1,94, 89.30 ,92.12, 89.30 , 91.18 , 89.30 ,Current Medicare Rates,91.18,90.24,Included in per diem,89.3,Included in ER Case rate,89.3,89.3, 92.12 ,84.6
30015190,EAP,CPT® 83655,,0301 - LABORATORY - CHEMISTRY,Hc Hvy Met Bld - Lead,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30015191,EAP,CPT® 83825,,0301 - LABORATORY - CHEMISTRY,Hc Hvy Met Bld - Mercury,1,94, 89.30 ,92.12, 89.30 , 91.18 , 89.30 ,Current Medicare Rates,91.18,90.24,Included in per diem,89.3,Included in ER Case rate,89.3,89.3, 92.12 ,84.6
30015193,EAP,CPT® 82300,,0301 - LABORATORY - CHEMISTRY,Hc Hvy Met Ur - Cadmium,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
30112365,EAP,CPT® 83498,,0301 - LABORATORY - CHEMISTRY,"Hc Hydroxyprogesterone, 17-d",1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30015207,EAP,CPT® 84155,,0301 - LABORATORY - CHEMISTRY,Hc Ife Serum-protein Total Serum,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30015213,EAP,CPT® 82785,,0301 - LABORATORY - CHEMISTRY,Hc Ige Serum Total,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30015218,EAP,CPT® 84305,,0301 - LABORATORY - CHEMISTRY,Hc Igf-1 Serum,1,171, 162.45 ,167.58, 162.45 , 165.87 , 162.45 ,Current Medicare Rates,165.87,164.16,Included in per diem,162.45,Included in ER Case rate,162.45,162.45, 167.58 ,153.9
30112599,EAP,CPT® 82787,,0301 - LABORATORY - CHEMISTRY,Hc Immunglb Igg Subclass 3,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30015239,EAP,CPT® 83519,,0301 - LABORATORY - CHEMISTRY,Hc Immunoassay Analyte Qnt,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30113289,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Immunoassay Analyte Qual/semiqual Multiple Step #,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30011994,EAP,CPT® 83520,,0301 - LABORATORY - CHEMISTRY,Hc Immunoassay Analyte Quantitative Nos,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30100118,EAP,83520,,0301 - LABORATORY - CHEMISTRY,HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30100121,EAP,83520,,0301 - LABORATORY - CHEMISTRY,HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS #,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30100018,EAP,CPT® 83520,,0301 - LABORATORY - CHEMISTRY,HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30100019,EAP,CPT® 83520,,0301 - LABORATORY - CHEMISTRY,HC IMMUNOASSAY ANALYTE QUANTITATIVE NOS #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30113501,EAP,CPT® 83520,,0301 - LABORATORY - CHEMISTRY,"Hc Immunoassay,quant Not Other Spec",1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30015298,EAP,CPT® 83540,,0301 - LABORATORY - CHEMISTRY,Hc Iron,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30113527,EAP,CPT® 83540,,0301 - LABORATORY - CHEMISTRY,HC IRON (FE)-83540,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30113528,EAP,CPT® 83550,,0301 - LABORATORY - CHEMISTRY,HC IRON BINDING CAP TOTAL 83550,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30015300,EAP,CPT® 83550,,0301 - LABORATORY - CHEMISTRY,HC IRON BINDING CAPACITY 83550,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30112117,EAP,CPT® 83550,,0301 - LABORATORY - CHEMISTRY,Hc Iron Binding Test,1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
30112517,EAP,CPT® 83883,,0301 - LABORATORY - CHEMISTRY,Hc Kappa Light Chain,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
30015346,EAP,CPT® 80299,,0301 - LABORATORY - CHEMISTRY,Hc Keppra Level,1,211, 200.45 ,206.78, 200.45 , 204.67 , 200.45 ,Current Medicare Rates,204.67,202.56,Included in per diem,200.45,Included in ER Case rate,200.45,200.45, 206.78 ,189.9
30015355,EAP,CPT® 83789,,0301 - LABORATORY - CHEMISTRY,Hc Lacosamide Serum,1,88, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
30015357,EAP,CPT® 83605,,0301 - LABORATORY - CHEMISTRY,Hc Lactate (lactic Acid),1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30113548,EAP,CPT® 83883,,0301 - LABORATORY - CHEMISTRY,Hc Lambda Free Light Chains,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30112736,EAP,CPT® 83615,,0301 - LABORATORY - CHEMISTRY,Hc Ldh Body Fluid,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30015373,EAP,CPT® 83615,,0301 - LABORATORY - CHEMISTRY,Hc Ldh Serum,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30112370,EAP,CPT® 83721,,0301 - LABORATORY - CHEMISTRY,Hc Ldl Direct,1,39, 37.05 ,38.22, 37.05 , 37.83 , 37.05 ,Current Medicare Rates,37.83,37.44,Included in per diem,37.05,Included in ER Case rate,37.05,37.05, 38.22 ,35.1
30015376,EAP,CPT® 83655,,0301 - LABORATORY - CHEMISTRY,Hc Lead Blood,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30015391,EAP,CPT® 83002,,0301 - LABORATORY - CHEMISTRY,Hc Lh,1,171, 162.45 ,167.58, 162.45 , 165.87 , 162.45 ,Current Medicare Rates,165.87,164.16,Included in per diem,162.45,Included in ER Case rate,162.45,162.45, 167.58 ,153.9
30015394,EAP,CPT® 80158,,0301 - LABORATORY - CHEMISTRY,Hc Liow Cyclosporine,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30013912,EAP,CPT® 83690,,0301 - LABORATORY - CHEMISTRY,Hc Lipase,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30112063,EAP,CPT® 80061,,0301 - LABORATORY - CHEMISTRY,Hc Lipid Panel,1,165, 156.75 ,161.7, 156.75 , 160.05 , 156.75 ,Current Medicare Rates,160.05,158.4,Included in per diem,156.75,Included in ER Case rate,156.75,156.75, 161.70 ,148.5
30015399,EAP,CPT® 83695,,0301 - LABORATORY - CHEMISTRY,Hc Lipoprotein A,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30013080,EAP,CPT® 83704,,0301 - LABORATORY - CHEMISTRY,Hc Lipoprotein Bld By Nmr,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30015059,EAP,CPT® 83718,,0301 - LABORATORY - CHEMISTRY,Hc Lipoprotein Hdl,1,121, 114.95 ,118.58, 114.95 , 117.37 , 114.95 ,Current Medicare Rates,117.37,116.16,Included in per diem,114.95,Included in ER Case rate,114.95,114.95, 118.58 ,108.9
30015406,EAP,CPT® 84081,,0301 - LABORATORY - CHEMISTRY,Hc Ls Ratio-pg,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30112248,EAP,CPT® 83735,,0301 - LABORATORY - CHEMISTRY,Hc Magnesium,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30015421,EAP,CPT® 83735,,0301 - LABORATORY - CHEMISTRY,Hc Magnesium Quant Urine,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30113587,EAP,CPT® 83735,,0301 - LABORATORY - CHEMISTRY,Hc Magnesium Random Urine,1,130, 123.50 ,127.4, 123.50 , 126.10 , 123.50 ,Current Medicare Rates,126.1,124.8,Included in per diem,123.5,Included in ER Case rate,123.5,123.5, 127.40 ,117
30113595,EAP,CPT® 83785,,0301 - LABORATORY - CHEMISTRY,"HC MANGANESE, SERUM",1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30113596,EAP,CPT® 83789,,0301 - LABORATORY - CHEMISTRY,Hc Mass Spec Tndm Ms Nes,1,89, 84.55 ,87.22, 84.55 , 86.33 , 84.55 ,Current Medicare Rates,86.33,85.44,Included in per diem,84.55,Included in ER Case rate,84.55,84.55, 87.22 ,80.1
30015448,EAP,CPT® 83835,,0301 - LABORATORY - CHEMISTRY,Hc Metanephrines Quant Plasma,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30113625,EAP,CPT® 83835,,0301 - LABORATORY - CHEMISTRY,Hc Metanephrines-total (24hr U),1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30110694,EAP,80358,,0301 - LABORATORY - CHEMISTRY,HC METHADONE-METAB UR GC/MS (ARUP),1,151, 143.45 ,147.98, 143.45 , 146.47 , 143.45 ,Current Medicare Rates,146.47,144.96,Included in per diem,143.45,Included in ER Case rate,143.45,143.45, 147.98 ,135.9
30015460,EAP,CPT® 83921,,0301 - LABORATORY - CHEMISTRY,Hc Methylmalonic Acid Level,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30110675,EAP,CPT® 80360,,0301 - LABORATORY - CHEMISTRY,Hc Methylphenidate,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30112020,EAP,CPT® 82043,,0301 - LABORATORY - CHEMISTRY,Hc Microalbumin Quantitative,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
30015518,EAP,CPT® 83864,,0301 - LABORATORY - CHEMISTRY,Hc Mucopolysaccharides Qnt Ur,1,320, 304.00 ,313.6, 304.00 , 310.40 , 304.00 ,Current Medicare Rates,310.4,307.2,Included in per diem,304,Included in ER Case rate,304,304, 313.60 ,288
30013923,EAP,CPT® 83873,,0301 - LABORATORY - CHEMISTRY,Hc Myelin Basic Protein Csf,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
30112024,EAP,CPT® 83880,,0301 - LABORATORY - CHEMISTRY,Hc Natriuretic Peptide,1,275, 261.25 ,269.5, 261.25 , 266.75 , 261.25 ,Current Medicare Rates,266.75,264,Included in per diem,261.25,Included in ER Case rate,261.25,261.25, 269.50 ,247.5
30015571,EAP,CPT® 83883,,0301 - LABORATORY - CHEMISTRY,Hc Nephelometry Each Analyte Not Elsewhere Specified,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
30015589,EAP,CPT® 82523,,0301 - LABORATORY - CHEMISTRY,Hc Ntx-telopeptide Urine,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30112076,EAP,CPT® 80055,,0301 - LABORATORY - CHEMISTRY,Hc Obstetric Panel,1,270, 256.50 ,264.6, 256.50 , 261.90 , 256.50 ,Current Medicare Rates,261.9,259.2,Included in per diem,256.5,Included in ER Case rate,256.5,256.5, 264.60 ,243
30013008,EAP,CPT® 82272,,0301 - LABORATORY - CHEMISTRY,Hc Occult Bld Feces 1-3 Tests,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30015613,EAP,CPT® 82271,,0301 - LABORATORY - CHEMISTRY,Hc Occult Blood Gastric,1,20, 19.00 ,19.6, 19.00 , 19.40 , 19.00 ,Current Medicare Rates,19.4,19.2,Included in per diem,19,Included in ER Case rate,19,19, 19.60 ,18
30112178,EAP,CPT® 83916,,0301 - LABORATORY - CHEMISTRY,Hc Oligoclonal Immune (oligoclonal Bands),1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
30013034,EAP,CPT® 83918,,0301 - LABORATORY - CHEMISTRY,Hc Organic Acids Total Quantitative Each Specimen,1,213, 202.35 ,208.74, 202.35 , 206.61 , 202.35 ,Current Medicare Rates,206.61,204.48,Included in per diem,202.35,Included in ER Case rate,202.35,202.35, 208.74 ,191.7
30112375,EAP,CPT® 83930,,0301 - LABORATORY - CHEMISTRY,Hc Osmolality,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30112044,EAP,CPT® 83935,,0301 - LABORATORY - CHEMISTRY,Hc Osmolality Urine,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30112351,EAP,CPT® 82042,,0301 - LABORATORY - CHEMISTRY,HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
30112077,EAP,CPT® 83945,,0301 - LABORATORY - CHEMISTRY,Hc Oxalate,1,140, 133.00 ,137.2, 133.00 , 135.80 , 133.00 ,Current Medicare Rates,135.8,134.4,Included in per diem,133,Included in ER Case rate,133,133, 137.20 ,126
30015633,EAP,CPT® 83945,,0301 - LABORATORY - CHEMISTRY,Hc Oxalate Quant Urine,1,140, 133.00 ,137.2, 133.00 , 135.80 , 133.00 ,Current Medicare Rates,135.8,134.4,Included in per diem,133,Included in ER Case rate,133,133, 137.20 ,126
30112161,EAP,CPT® 83970,,0301 - LABORATORY - CHEMISTRY,Hc Parathormone (parathyroid Hormone),1,377, 358.15 ,369.46, 358.15 , 365.69 , 358.15 ,Current Medicare Rates,365.69,361.92,Included in per diem,358.15,Included in ER Case rate,358.15,358.15, 369.46 ,339.3
30015655,EAP,CPT® 83970,,0301 - LABORATORY - CHEMISTRY,Hc Parathyroid Hormone Intact,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30112756,EAP,CPT® 83986,,0301 - LABORATORY - CHEMISTRY,Hc Ph (body Fluid),1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30112035,EAP,CPT® 83986,,0301 - LABORATORY - CHEMISTRY,Hc Ph Body Fluid Not Otherwise Specified,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30112222,EAP,CPT® 84080,,0301 - LABORATORY - CHEMISTRY,Hc Phosphatase Alkaline Isoenzymes,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30015691,EAP,CPT® 84105,,0301 - LABORATORY - CHEMISTRY,Hc Phosphorus Quant Urine,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,Included in per diem,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
30112072,EAP,CPT® 84105,,0301 - LABORATORY - CHEMISTRY,Hc Phosphorus Urine,1,64, 60.80 ,62.72, 60.80 , 62.08 , 60.80 ,Current Medicare Rates,62.08,61.44,Included in per diem,60.8,Included in ER Case rate,60.8,60.8, 62.72 ,57.6
30013783,EAP,CPT® 84112,,0301 - LABORATORY - CHEMISTRY,Hc Placental Alpha Microglobulin 1 Qualitative,1,259, 246.05 ,253.82, 246.05 , 251.23 , 246.05 ,Current Medicare Rates,251.23,248.64,Included in per diem,246.05,Included in ER Case rate,246.05,246.05, 253.82 ,233.1
30015719,EAP,CPT® 84110,,0301 - LABORATORY - CHEMISTRY,Hc Porphobilinogen Quant Urine,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30013218,EAP,CPT® 84120,,0301 - LABORATORY - CHEMISTRY,Hc Porphyrins Fract Quant Ur (arup),1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30013108,EAP,CPT® 84119,,0301 - LABORATORY - CHEMISTRY,Hc Porphyrins Urine Qualitative,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30112229,EAP,CPT® 84132,,0301 - LABORATORY - CHEMISTRY,Hc Potassium,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30112055,EAP,CPT® 84133,,0301 - LABORATORY - CHEMISTRY,Hc Potassium Urine,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30112045,EAP,CPT® 84134,,0301 - LABORATORY - CHEMISTRY,Hc Prealbumin,1,1110," 1,054.50 ",1087.8," 1,054.50 "," 1,076.70 "," 1,054.50 ",Current Medicare Rates,1076.7,1065.6,Included in per diem,1054.5,Included in ER Case rate,1054.5,1054.5," 1,087.80 ",999
30112528,EAP,CPT® 84163,,0301 - LABORATORY - CHEMISTRY,Hc Pregnancy Associated Plasma Protein A (papp A),1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
30013109,EAP,CPT® 84140,,0301 - LABORATORY - CHEMISTRY,Hc Pregnenolone,1,179, 170.05 ,175.42, 170.05 , 173.63 , 170.05 ,Current Medicare Rates,173.63,171.84,Included in per diem,170.05,Included in ER Case rate,170.05,170.05, 175.42 ,161.1
30013086,EAP,CPT® 84145,,0301 - LABORATORY - CHEMISTRY,Hc Procalcitonin,1,290, 275.50 ,284.2, 275.50 , 281.30 , 275.50 ,Current Medicare Rates,281.3,278.4,Included in per diem,275.5,Included in ER Case rate,275.5,275.5, 284.20 ,261
30112067,EAP,CPT® 84144,,0301 - LABORATORY - CHEMISTRY,Hc Progesterone,1,171, 162.45 ,167.58, 162.45 , 165.87 , 162.45 ,Current Medicare Rates,165.87,164.16,Included in per diem,162.45,Included in ER Case rate,162.45,162.45, 167.58 ,153.9
30112073,EAP,CPT® 84146,,0301 - LABORATORY - CHEMISTRY,Hc Prolactin,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30112377,EAP,CPT® 84150,,0301 - LABORATORY - CHEMISTRY,Hc Prostaglandin Each,1,586, 556.70 ,574.28, 556.70 , 568.42 , 556.70 ,Current Medicare Rates,568.42,562.56,Included in per diem,556.7,Included in ER Case rate,556.7,556.7, 574.28 ,527.4
30015761,EAP,CPT® 84153,,0301 - LABORATORY - CHEMISTRY,Hc Prostate Specific Antigen (psa) Total,1,145, 137.75 ,142.1, 137.75 , 140.65 , 137.75 ,Current Medicare Rates,140.65,139.2,Included in per diem,137.75,Included in ER Case rate,137.75,137.75, 142.10 ,130.5
30112165,EAP,CPT® 84154,,0301 - LABORATORY - CHEMISTRY,Hc Prostate Specific Antigen Free,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
30015763,EAP,CPT® 84165,,0301 - LABORATORY - CHEMISTRY,Hc Prot Elp-protein Elp Serum,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30015764,EAP,CPT® 84155,,0301 - LABORATORY - CHEMISTRY,Hc Prot Elp-protein Total Serum,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30113805,EAP,CPT® 84156,,0301 - LABORATORY - CHEMISTRY,Hc Protein 12 Hr Urine,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30013090,EAP,CPT® 84157,,0301 - LABORATORY - CHEMISTRY,Hc Protein Total Other Source,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30015783,EAP,CPT® 84156,,0301 - LABORATORY - CHEMISTRY,Hc Protein Total Urine Pamc,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30013098,EAP,CPT® 84156,,0301 - LABORATORY - CHEMISTRY,Hc Protein Urine,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30015809,EAP,CPT® 84154,,0301 - LABORATORY - CHEMISTRY,Hc Psa Free,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30110064,EAP,CPT® 84153,,0301 - LABORATORY - CHEMISTRY,Hc Psa Screening,1,168, 159.60 ,164.64, 159.60 , 162.96 , 159.60 ,Current Medicare Rates,162.96,161.28,Included in per diem,159.6,Included in ER Case rate,159.6,159.6, 164.64 ,151.2
30015810,EAP,CPT® 84153,,0301 - LABORATORY - CHEMISTRY,Hc Psa Ultrasensitive,1,176, 167.20 ,172.48, 167.20 , 170.72 , 167.20 ,Current Medicare Rates,170.72,168.96,Included in per diem,167.2,Included in ER Case rate,167.2,167.2, 172.48 ,158.4
30112130,EAP,CPT® 80299,,0301 - LABORATORY - CHEMISTRY,Hc Quantitative Assay Drug Lamotrigine,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
30112215,EAP,CPT® 80299,,0301 - LABORATORY - CHEMISTRY,Hc Quantitative Assay Drug Methotrexate,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30112144,EAP,CPT® 83018,,0301 - LABORATORY - CHEMISTRY,Hc Quantitative Screen Metals,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30015863,EAP,CPT® 83735,,0301 - LABORATORY - CHEMISTRY,Hc Rbc Magnesium,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30112064,EAP,CPT® 80069,,0301 - LABORATORY - CHEMISTRY,Hc Renal Panel,1,130, 123.50 ,127.4, 123.50 , 126.10 , 123.50 ,Current Medicare Rates,126.1,124.8,Included in per diem,123.5,Included in ER Case rate,123.5,123.5, 127.40 ,117
30112051,EAP,CPT® 84244,,0301 - LABORATORY - CHEMISTRY,Hc Renin,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30015879,EAP,CPT® 84244,,0301 - LABORATORY - CHEMISTRY,Hc Renin Activity,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30112286,EAP,CPT® 84252,,0301 - LABORATORY - CHEMISTRY,Hc Riboflavin Vitamin B 2,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
30015206,EAP,CPT® 84165,,0301 - LABORATORY - CHEMISTRY,Hc Serum-protein Elp Serum,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30015928,EAP,CPT® 84270,,0301 - LABORATORY - CHEMISTRY,Hc Sex Hormone Binding Globulin,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30112384,EAP,CPT® 84450,,0301 - LABORATORY - CHEMISTRY,Hc Sgot (ast),1,79, 75.05 ,77.42, 75.05 , 76.63 , 75.05 ,Current Medicare Rates,76.63,75.84,Included in per diem,75.05,Included in ER Case rate,75.05,75.05, 77.42 ,71.1
30015931,EAP,CPT® 84460,,0301 - LABORATORY - CHEMISTRY,Hc Sgpt (alt),1,108, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
30013978,EAP,CPT® 84295,,0301 - LABORATORY - CHEMISTRY,Hc Sodium,1,73, 69.35 ,71.54, 69.35 , 70.81 , 69.35 ,Current Medicare Rates,70.81,70.08,Included in per diem,69.35,Included in ER Case rate,69.35,69.35, 71.54 ,65.7
30112190,EAP,CPT® 84302,,0301 - LABORATORY - CHEMISTRY,Hc Sodium Other Source,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
30112172,EAP,CPT® 84300,,0301 - LABORATORY - CHEMISTRY,Hc Sodium Urine,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30112012,EAP,CPT® 84305,,0301 - LABORATORY - CHEMISTRY,Hc Somatomedin,1,174, 165.30 ,170.52, 165.30 , 168.78 , 165.30 ,Current Medicare Rates,168.78,167.04,Included in per diem,165.3,Included in ER Case rate,165.3,165.3, 170.52 ,156.6
30013003,EAP,CPT® 84315,,0301 - LABORATORY - CHEMISTRY,Hc Specific Gravity Except Urine,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30015997,EAP,CPT® 84480,,0301 - LABORATORY - CHEMISTRY,Hc T3 Icma,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30015998,EAP,CPT® 84482,,0301 - LABORATORY - CHEMISTRY,Hc T3 Reverse Esoterix,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30016000,EAP,CPT® 84479,,0301 - LABORATORY - CHEMISTRY,Hc T3 Uptake,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30114290,EAP,CPT® 81479,,0301 - LABORATORY - CHEMISTRY,Hc T-cell Receptor Excisn Circles,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30112025,EAP,CPT® 82009,,0301 - LABORATORY - CHEMISTRY,Hc Test For Acetone/ketones,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30112336,EAP,CPT® 84403,,0301 - LABORATORY - CHEMISTRY,Hc Testosterone,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30112048,EAP,CPT® 84402,,0301 - LABORATORY - CHEMISTRY,Hc Testosterone Free,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30112115,EAP,CPT® 84403,,0301 - LABORATORY - CHEMISTRY,Hc Testosterone Total,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30013021,EAP,CPT® 84432,,0301 - LABORATORY - CHEMISTRY,Hc Thyroglobulin,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30016040,EAP,CPT® 84445,,0301 - LABORATORY - CHEMISTRY,Hc Thyroid Stim Immunoglob,1,285, 270.75 ,279.3, 270.75 , 276.45 , 270.75 ,Current Medicare Rates,276.45,273.6,Included in per diem,270.75,Included in ER Case rate,270.75,270.75, 279.30 ,256.5
30112017,EAP,CPT® 84443,,0301 - LABORATORY - CHEMISTRY,Hc Thyroid Stimulating Hormone Tsh,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,Included in per diem,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
30114165,EAP,CPT® 84442,,0301 - LABORATORY - CHEMISTRY,Hc Thyroxine Binding Globulin Tbg,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30016044,EAP,CPT® 84436,,0301 - LABORATORY - CHEMISTRY,Hc Thyroxine T4,1,87, 82.65 ,85.26, 82.65 , 84.39 , 82.65 ,Current Medicare Rates,84.39,83.52,Included in per diem,82.65,Included in ER Case rate,82.65,82.65, 85.26 ,78.3
30112118,EAP,CPT® 84436,,0301 - LABORATORY - CHEMISTRY,Hc Thyroxine Total,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
30013138,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Tissue Transglutaminase Ab Iga,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30016055,EAP,CPT® 83516,,0301 - LABORATORY - CHEMISTRY,Hc Tissue Transglutimase,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30112175,EAP,CPT® 84446,,0301 - LABORATORY - CHEMISTRY,Hc Tocopherol Alpha Vitamin E,1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
30112314,EAP,CPT® 84155,,0301 - LABORATORY - CHEMISTRY,Hc Total Protein,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
30016086,EAP,CPT® 84478,,0301 - LABORATORY - CHEMISTRY,Hc Triglycerides,1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,Included in per diem,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30016091,EAP,CPT® 84484,,0301 - LABORATORY - CHEMISTRY,Hc Troponin Quantitative,1,150, 142.50 ,147, 142.50 , 145.50 , 142.50 ,Current Medicare Rates,145.5,144,Included in per diem,142.5,Included in ER Case rate,142.5,142.5, 147.00 ,135
30112660,EAP,CPT® 84443,,0301 - LABORATORY - CHEMISTRY,Hc Tsh,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30112778,EAP,CPT® 84540,,0301 - LABORATORY - CHEMISTRY,Hc Urea Nitrogen-24 Hr Urine,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30016112,EAP,CPT® 84540,,0301 - LABORATORY - CHEMISTRY,Hc Urea Quant Urine,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
30112261,EAP,CPT® 84545,,0301 - LABORATORY - CHEMISTRY,Hc Urea-n Clearance Test,1,99, 94.05 ,97.02, 94.05 , 96.03 , 94.05 ,Current Medicare Rates,96.03,95.04,Included in per diem,94.05,Included in ER Case rate,94.05,94.05, 97.02 ,89.1
30110077,EAP,CPT® 84550,,0301 - LABORATORY - CHEMISTRY,Hc Uric Acid Blood,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30016119,EAP,CPT® 84560,,0301 - LABORATORY - CHEMISTRY,Hc Uric Acid Quant Urine,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30114230,EAP,CPT® 84560,,0301 - LABORATORY - CHEMISTRY,Hc Uric Acid Urine Random,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30016167,EAP,CPT® 83701,,0301 - LABORATORY - CHEMISTRY,Hc Vap - Lipoproteins Hr Quant,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
30016184,EAP,CPT® 84425,,0301 - LABORATORY - CHEMISTRY,Hc Vitamin B-1 Level,1,93, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,Included in per diem,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
30112443,EAP,CPT® 84425,,0301 - LABORATORY - CHEMISTRY,Hc Vitamin B1 Whole Blood (arup),1,255, 242.25 ,249.9, 242.25 , 247.35 , 242.25 ,Current Medicare Rates,247.35,244.8,Included in per diem,242.25,Included in ER Case rate,242.25,242.25, 249.90 ,229.5
30016188,EAP,CPT® 84207,,0301 - LABORATORY - CHEMISTRY,Hc Vitamin B-6 Level,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30114257,EAP,CPT® 82180,,0301 - LABORATORY - CHEMISTRY,"Hc Vitamin C, Plasma",1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30016189,EAP,CPT® 82652,,0301 - LABORATORY - CHEMISTRY,Hc Vitamin D 1 25 Dihydro,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30013010,EAP,CPT® 82306,,0301 - LABORATORY - CHEMISTRY,HC VITAMIN D 25 HYDROXY,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30016196,EAP,CPT® 82607,,0301 - LABORATORY - CHEMISTRY,Hc Vitamin-b12,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30013266,EAP,CPT® 80194,,0301 - LABORATORY - CHEMISTRY,Hc Z80194 Ref Lab,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
30013365,EAP,CPT® 82735,,0301 - LABORATORY - CHEMISTRY,Hc Z82735 Ref Lab,1,218, 207.10 ,213.64, 207.10 , 211.46 , 207.10 ,Current Medicare Rates,211.46,209.28,Included in per diem,207.1,Included in ER Case rate,207.1,207.1, 213.64 ,196.2
30013391,EAP,CPT® 83069,,0301 - LABORATORY - CHEMISTRY,Hc Z83069 (ref Lab),1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30016230,EAP,CPT® 84630,,0301 - LABORATORY - CHEMISTRY,Hc Zinc Serum,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30013730,EAP,CPT® 80184,,0301 - LABORATORY - CHEMISTRY,Hc Zphenobarbital (arup),1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
30013733,EAP,CPT® 80188,,0301 - LABORATORY - CHEMISTRY,Hc Zprimidone (arup),1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
30210575,EAP,86382,,0302 - LABORATORY - IMMUNOLOGY,HC NEUTRALIZATION TEST VIRAL,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30200048,EAP,86408,,0302 - LABORATORY - IMMUNOLOGY,HC NEUTRALIZING ANTIBODY SARS-COV-2 SCREEN,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30200049,EAP,86409,,0302 - LABORATORY - IMMUNOLOGY,HC NEUTRALIZING ANTIBODY SARS-COV-2 TITER,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30200132,EAP,86592,,0302 - LABORATORY - IMMUNOLOGY,HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL #,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30200133,EAP,86592,,0302 - LABORATORY - IMMUNOLOGY,HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL #,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30200149,EAP,86480,,0302 - LABORATORY - IMMUNOLOGY,HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON #,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,Included in per diem,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
30200113,EAP,86800,,0302 - LABORATORY - IMMUNOLOGY,HC THYROGLOBULIN ANTIBODY #,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30210907,EAP,CPT® 86900,,0302 - LABORATORY - IMMUNOLOGY,Hc Abo,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30010401,EAP,CPT® 86000,,0302 - LABORATORY - IMMUNOLOGY,Hc Agglutinins Febrile,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30200135,EAP,86003,,0302 - LABORATORY - IMMUNOLOGY,HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
30200123,EAP,86003,,0302 - LABORATORY - IMMUNOLOGY,HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30210267,EAP,CPT® 86003,,0302 - LABORATORY - IMMUNOLOGY,Hc Allergen Spec Ige Crude Allergen Extract Each #,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
30211254,EAP,86005,,0302 - LABORATORY - IMMUNOLOGY,HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN #,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
30210302,EAP,CPT® 86003,,0302 - LABORATORY - IMMUNOLOGY,Hc Allergen Specific Ige,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
30011463,EAP,CPT® 86003,,0302 - LABORATORY - IMMUNOLOGY,Hc Allergen Specific Ige - Ea,1,33, 31.35 ,32.34, 31.35 , 32.01 , 31.35 ,Current Medicare Rates,32.01,31.68,Included in per diem,31.35,Included in ER Case rate,31.35,31.35, 32.34 ,29.7
30210903,EAP,CPT® 86003,,0302 - LABORATORY - IMMUNOLOGY,Hc Allergen Specific Ige - Quant Ige,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30016288,EAP,CPT® 86003,,0302 - LABORATORY - IMMUNOLOGY,Hc Allergen Specific Ige Panel Each Allergen,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
30011359,EAP,86001,,0302 - LABORATORY - IMMUNOLOGY,HC ALLERGEN SPECIFIC IGG,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
30010003,EAP,CPT® 86008,,0302 - LABORATORY - IMMUNOLOGY,Hc Allg Spec Ige Recomb Ea,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30200109,EAP,86635,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY COCCIDIOIDES #,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30200131,EAP,86635,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY COCCIDIOIDES #,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30200144,EAP,86635,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY COCCIDIOIDES #,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30210253,EAP,CPT® 86644,,0302 - LABORATORY - IMMUNOLOGY,Hc Antibody Cytomegalovirus Cmv #,1,152, 144.40 ,148.96, 144.40 , 147.44 , 144.40 ,Current Medicare Rates,147.44,145.92,Included in per diem,144.4,Included in ER Case rate,144.4,144.4, 148.96 ,136.8
30200128,EAP,86664,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA #,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30200141,EAP,86664,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA #,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30200129,EAP,86665,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA #,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30200139,EAP,86665,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA #,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30200140,EAP,86665,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA #,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30200118,EAP,86735,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY MUMPS #,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30200130,EAP,86735,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY MUMPS #,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30211093,EAP,CPT® 86850,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY SCREEN,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30210906,EAP,CPT® 86886,,0302 - LABORATORY - IMMUNOLOGY,Hc Antibody Titer,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30200108,EAP,86777,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA #,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30200142,EAP,86777,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA #,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30200108,EAP,86777,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA #,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30200142,EAP,86777,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA #,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30200138,EAP,86778,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA IGM #,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
30200143,EAP,86778,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA IGM #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30200138,EAP,86778,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA IGM #,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
30200143,EAP,86778,,0302 - LABORATORY - IMMUNOLOGY,HC ANTIBODY TOXOPLASMA IGM #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30011023,EAP,CPT® 86038,,0302 - LABORATORY - IMMUNOLOGY,Hc Antinuclear Antibodies,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30210369,EAP,CPT® 86038,,0302 - LABORATORY - IMMUNOLOGY,Hc Antinuclear Antibodies - Ana,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30210354,EAP,CPT® 86039,,0302 - LABORATORY - IMMUNOLOGY,Hc Antinuclear Antibodies (ana) Titer,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30210244,EAP,CPT® 86038,,0302 - LABORATORY - IMMUNOLOGY,Hc Antinuclear Antibodies Ana #,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30210311,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Anti-ssa (ro) Quantitative,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
30210312,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Anti-ssb (la) Quantitative,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
30210393,EAP,CPT® 86060,,0302 - LABORATORY - IMMUNOLOGY,Hc Antistreptolysin O Titer,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30210330,EAP,CPT® 86972,,0302 - LABORATORY - IMMUNOLOGY,Hc Arc Retic Separation,1,205, 194.75 ,200.9, 194.75 , 198.85 , 194.75 ,Current Medicare Rates,198.85,196.8,Included in per diem,194.75,Included in ER Case rate,194.75,194.75, 200.90 ,184.5
30210331,EAP,CPT® 86976,,0302 - LABORATORY - IMMUNOLOGY,Hc Arc Serum Dil In Ab Id,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30210616,EAP,CPT® 86606,,0302 - LABORATORY - IMMUNOLOGY,Hc Aspergillus Antibody,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30010637,EAP,CPT® 86355,,0302 - LABORATORY - IMMUNOLOGY,Hc B Cells Total Count,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30210339,EAP,CPT® 86611,,0302 - LABORATORY - IMMUNOLOGY,Hc Bartonella Antibody,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30010429,EAP,CPT® 86146,,0302 - LABORATORY - IMMUNOLOGY,Hc Beta 2 Glycoprotein I Antibody,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
30010706,EAP,CPT® 86612,,0302 - LABORATORY - IMMUNOLOGY,Hc Blastomyces Antibody,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30011095,EAP,CPT® 86902,,0302 - LABORATORY - IMMUNOLOGY,Hc Blood Type Antigen Donor Ea - Per Unit,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30011111,EAP,CPT® 86904,,0302 - LABORATORY - IMMUNOLOGY,Hc Blood Typing Patient Serum,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
30011114,EAP,CPT® 86905,,0302 - LABORATORY - IMMUNOLOGY,HC BLOOD TYPING RBC ANTIGENS,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30011963,EAP,CPT® 86906,,0302 - LABORATORY - IMMUNOLOGY,Hc Blood Typing Rh Phenotype,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30011083,EAP,CPT® 86900,,0302 - LABORATORY - IMMUNOLOGY,Hc Blood Typing Serologic; Abo,1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30010682,EAP,CPT® 86615,,0302 - LABORATORY - IMMUNOLOGY,Hc Bordetella Antibody,1,49, 46.55 ,48.02, 46.55 , 47.53 , 46.55 ,Current Medicare Rates,47.53,47.04,Included in per diem,46.55,Included in ER Case rate,46.55,46.55, 48.02 ,44.1
30210627,EAP,CPT® 86622,,0302 - LABORATORY - IMMUNOLOGY,Hc Brucella Antibody,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30010431,EAP,CPT® 86161,,0302 - LABORATORY - IMMUNOLOGY,Hc C-1-esterase Inhib Func(arup),1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,Included in per diem,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30011484,EAP,CPT® 86160,,0302 - LABORATORY - IMMUNOLOGY,Hc C-1-esterase Inhibitor(arup),1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,Included in per diem,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30010736,EAP,CPT® 86628,,0302 - LABORATORY - IMMUNOLOGY,Hc Candida Antibody,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30210405,EAP,CPT® 86147,,0302 - LABORATORY - IMMUNOLOGY,Hc Cardiolipin Antibody,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
30200134,EAP,86147,,0302 - LABORATORY - IMMUNOLOGY,HC CARDIOLIPIN ANTIBODY EACH IG CLASS #,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
30200137,EAP,86147,,0302 - LABORATORY - IMMUNOLOGY,HC CARDIOLIPIN ANTIBODY EACH IG CLASS #,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
30210409,EAP,CPT® 86147,,0302 - LABORATORY - IMMUNOLOGY,Hc Cardiolipin Antibody Each Ig Class #,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
30010438,EAP,CPT® 86200,,0302 - LABORATORY - IMMUNOLOGY,Hc Ccp Antibody,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30210406,EAP,CPT® 86632,,0302 - LABORATORY - IMMUNOLOGY,Hc Chlamydia Igm Antibody,1,41, 38.95 ,40.18, 38.95 , 39.77 , 38.95 ,Current Medicare Rates,39.77,39.36,Included in per diem,38.95,Included in ER Case rate,38.95,38.95, 40.18 ,36.9
30012120,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Chromatin Autoantibodies,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
30010753,EAP,CPT® 86644,,0302 - LABORATORY - IMMUNOLOGY,Hc Cmv Antibody,1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
30010765,EAP,CPT® 86645,,0302 - LABORATORY - IMMUNOLOGY,Hc Cmv Antibody Igm,1,105, 99.75 ,102.9, 99.75 , 101.85 , 99.75 ,Current Medicare Rates,101.85,100.8,Included in per diem,99.75,Included in ER Case rate,99.75,99.75, 102.90 ,94.5
30210650,EAP,CPT® 86635,,0302 - LABORATORY - IMMUNOLOGY,Hc Coccidioides Antibody,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30211518,EAP,CPT® 86635,,0302 - LABORATORY - IMMUNOLOGY,Hc Coccidioides Antibody Igg,1,56, 53.20 ,54.88, 53.20 , 54.32 , 53.20 ,Current Medicare Rates,54.32,53.76,Included in per diem,53.2,Included in ER Case rate,53.2,53.2, 54.88 ,50.4
30210657,EAP,CPT® 86635,,0302 - LABORATORY - IMMUNOLOGY,Hc Coccidioides Antibody Igm,1,56, 53.20 ,54.88, 53.20 , 54.32 , 53.20 ,Current Medicare Rates,54.32,53.76,Included in per diem,53.2,Included in ER Case rate,53.2,53.2, 54.88 ,50.4
30210423,EAP,CPT® 86156,,0302 - LABORATORY - IMMUNOLOGY,Hc Cold Agglutinin Screen,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
30011123,EAP,CPT® 86922,,0302 - LABORATORY - IMMUNOLOGY,Hc Compatibility Test Antiglob,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
30210459,EAP,CPT® 86160,,0302 - LABORATORY - IMMUNOLOGY,Hc Complement Antigen,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30210429,EAP,CPT® 86160,,0302 - LABORATORY - IMMUNOLOGY,Hc Complement Antigen - C3,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30210430,EAP,CPT® 86160,,0302 - LABORATORY - IMMUNOLOGY,Hc Complement Antigen - C4,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30200124,EAP,86160,,0302 - LABORATORY - IMMUNOLOGY,HC COMPLEMENT ANTIGEN EACH COMPONENT #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30200125,EAP,86160,,0302 - LABORATORY - IMMUNOLOGY,HC COMPLEMENT ANTIGEN EACH COMPONENT #,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
30200136,EAP,86160,,0302 - LABORATORY - IMMUNOLOGY,HC COMPLEMENT ANTIGEN EACH COMPONENT #,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
30210418,EAP,CPT® 86162,,0302 - LABORATORY - IMMUNOLOGY,Hc Complement Total (ch50),1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30011075,EAP,CPT® 86880,,0302 - LABORATORY - IMMUNOLOGY,Hc Coombs Test Direct - Dat,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30011076,EAP,CPT® 86885,,0302 - LABORATORY - IMMUNOLOGY,Hc Coombs Test Indirect Qual,1,56, 53.20 ,54.88, 53.20 , 54.32 , 53.20 ,Current Medicare Rates,54.32,53.76,Included in per diem,53.2,Included in ER Case rate,53.2,53.2, 54.88 ,50.4
30011079,EAP,CPT® 86886,,0302 - LABORATORY - IMMUNOLOGY,HC COOMBS TEST INDIRECT TITER,1,131, 124.45 ,128.38, 124.45 , 127.07 , 124.45 ,Current Medicare Rates,127.07,125.76,Included in per diem,124.45,Included in ER Case rate,124.45,124.45, 128.38 ,117.9
30100131,EAP,82530,,0302 - LABORATORY - IMMUNOLOGY,HC CORTISOL FREE #,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30100144,EAP,82530,,0302 - LABORATORY - IMMUNOLOGY,HC CORTISOL FREE #,1,108, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
30210399,EAP,CPT® 86140,,0302 - LABORATORY - IMMUNOLOGY,Hc C-reactive Protein,1,73, 69.35 ,71.54, 69.35 , 70.81 , 69.35 ,Current Medicare Rates,70.81,70.08,Included in per diem,69.35,Included in ER Case rate,69.35,69.35, 71.54 ,65.7
30010421,EAP,CPT® 86141,,0302 - LABORATORY - IMMUNOLOGY,Hc Crp High Sensitivity,1,87, 82.65 ,85.26, 82.65 , 84.39 , 82.65 ,Current Medicare Rates,84.39,83.52,Included in per diem,82.65,Included in ER Case rate,82.65,82.65, 85.26 ,78.3
30011070,EAP,CPT® 86880,,0302 - LABORATORY - IMMUNOLOGY,Hc Direct Coombs,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30210468,EAP,CPT® 86225,,0302 - LABORATORY - IMMUNOLOGY,Hc Dna Antibody,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30210470,EAP,CPT® 86225,,0302 - LABORATORY - IMMUNOLOGY,Hc Dna Antibody - Ds,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30010693,EAP,CPT® 86226,,0302 - LABORATORY - IMMUNOLOGY,Hc Dna Antibody Single Strand,1,49, 46.55 ,48.02, 46.55 , 47.53 , 46.55 ,Current Medicare Rates,47.53,47.04,Included in per diem,46.55,Included in ER Case rate,46.55,46.55, 48.02 ,44.1
30012282,EAP,CPT® 86666,,0302 - LABORATORY - IMMUNOLOGY,Hc Ehrlichia Antibody Igm,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
30010775,EAP,CPT® 86651,,0302 - LABORATORY - IMMUNOLOGY,Hc Encephalitis Antibody - Ca Ab Csf Igg,1,49, 46.55 ,48.02, 46.55 , 47.53 , 46.55 ,Current Medicare Rates,47.53,47.04,Included in per diem,46.55,Included in ER Case rate,46.55,46.55, 48.02 ,44.1
30010793,EAP,CPT® 86653,,0302 - LABORATORY - IMMUNOLOGY,Hc Encephalitis Antibody - 'st Louis Ab Csf Igg,1,49, 46.55 ,48.02, 46.55 , 47.53 , 46.55 ,Current Medicare Rates,47.53,47.04,Included in per diem,46.55,Included in ER Case rate,46.55,46.55, 48.02 ,44.1
30010805,EAP,CPT® 86654,,0302 - LABORATORY - IMMUNOLOGY,Hc Encephalitis Antibody - W Igg Ab,1,49, 46.55 ,48.02, 46.55 , 47.53 , 46.55 ,Current Medicare Rates,47.53,47.04,Included in per diem,46.55,Included in ER Case rate,46.55,46.55, 48.02 ,44.1
30010814,EAP,86664,,0302 - LABORATORY - IMMUNOLOGY,Hc Epstein-barr Antibody  Nuclear Antigen,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
30010822,EAP,CPT® 86665,,0302 - LABORATORY - IMMUNOLOGY,Hc Epstein-barr Antibody - Viral Capsid,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30010809,EAP,CPT® 86663,,0302 - LABORATORY - IMMUNOLOGY,Hc Epstein-barr Antibody Early Antigen,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
30210501,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Extractable Nuclear Antigen Antibody Any Method #,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30010473,EAP,CPT® 86255,,0302 - LABORATORY - IMMUNOLOGY,Hc Fluorescent Antibody Screen - Mitochondrial,1,42, 39.90 ,41.16, 39.90 , 40.74 , 39.90 ,Current Medicare Rates,40.74,40.32,Included in per diem,39.9,Included in ER Case rate,39.9,39.9, 41.16 ,37.8
30010495,EAP,CPT® 86255,,0302 - LABORATORY - IMMUNOLOGY,Hc Fluorescent Antibody Screen Ab,1,42, 39.90 ,41.16, 39.90 , 40.74 , 39.90 ,Current Medicare Rates,40.74,40.32,Included in per diem,39.9,Included in ER Case rate,39.9,39.9, 41.16 ,37.8
30010512,EAP,CPT® 86256,,0302 - LABORATORY - IMMUNOLOGY,Hc Fluorescent Antibody Titer,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30010836,EAP,CPT® 86668,,0302 - LABORATORY - IMMUNOLOGY,Hc Francisella Tularensis,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30210707,EAP,CPT® 86671,,0302 - LABORATORY - IMMUNOLOGY,Hc Fungus Antibody,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30010846,EAP,CPT® 86677,,0302 - LABORATORY - IMMUNOLOGY,HC HELICOBACTER PYLORI,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30010843,EAP,CPT® 86677,,0302 - LABORATORY - IMMUNOLOGY,Hc Helicobacter Pylori - Igm,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30010844,EAP,CPT® 86677,,0302 - LABORATORY - IMMUNOLOGY,Hc Helicobacter Pylori Antibody,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30010853,EAP,CPT® 86682,,0302 - LABORATORY - IMMUNOLOGY,Hc Helminth Antibody,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30011859,EAP,CPT® 86709,,0302 - LABORATORY - IMMUNOLOGY,Hc Hep A Antibody Igm Ab,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
30210737,EAP,CPT® 86708,,0302 - LABORATORY - IMMUNOLOGY,Hc Hep A Antibody Total,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30210738,EAP,CPT® 86708,,0302 - LABORATORY - IMMUNOLOGY,Hc Hep A Antibody Total - Antihistone,1,64, 60.80 ,62.72, 60.80 , 62.08 , 60.80 ,Current Medicare Rates,62.08,61.44,Included in per diem,60.8,Included in ER Case rate,60.8,60.8, 62.72 ,57.6
30210943,EAP,CPT® 86704,,0302 - LABORATORY - IMMUNOLOGY,Hc Hep B Core Antibody Total,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30210735,EAP,CPT® 86706,,0302 - LABORATORY - IMMUNOLOGY,Hc Hep B Surface Ab,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30200126,EAP,86708,,0302 - LABORATORY - IMMUNOLOGY,HC HEPATITIS A ANTIBODY HAAB #,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30200127,EAP,86708,,0302 - LABORATORY - IMMUNOLOGY,HC HEPATITIS A ANTIBODY HAAB #,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30200153,EAP,86709,,0302 - LABORATORY - IMMUNOLOGY,HC HEPATITIS ANTIBODY HAAB IGM ANTIBODY #,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
30010459,EAP,CPT® 86707,,0302 - LABORATORY - IMMUNOLOGY,Hc Hepatitis Be Antibody (arup),1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30011021,EAP,CPT® 86804,,0302 - LABORATORY - IMMUNOLOGY,Hc Hepatitis C Ab (riba)(arup),1,134, 127.30 ,131.32, 127.30 , 129.98 , 127.30 ,Current Medicare Rates,129.98,128.64,Included in per diem,127.3,Included in ER Case rate,127.3,127.3, 131.32 ,120.6
30010872,EAP,CPT® 86692,,0302 - LABORATORY - IMMUNOLOGY,Hc Hepatitis Delta Agent,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30010889,EAP,CPT® 86695,,0302 - LABORATORY - IMMUNOLOGY,Hc Herpes Simplex 1 Test,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30010368,EAP,CPT® 86694,,0302 - LABORATORY - IMMUNOLOGY,Hc Herpes Simplex Test - Antibody Igm,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30210526,EAP,CPT® 86695,,0302 - LABORATORY - IMMUNOLOGY,Hc Herpes Simplex Test - Igg/igm,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30210524,EAP,CPT® 86695,,0302 - LABORATORY - IMMUNOLOGY,Hc Herpes Simplex Test - Type 1 Igg,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30010903,EAP,CPT® 86696,,0302 - LABORATORY - IMMUNOLOGY,Hc Herpes Simplex Type 2,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30010910,EAP,CPT® 86696,,0302 - LABORATORY - IMMUNOLOGY,Hc Herpes Simplex Type 2 -hsv 1&2 Igg-hsv Type 2,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30210538,EAP,CPT® 86308,,0302 - LABORATORY - IMMUNOLOGY,Hc Heterophile Antibodies,1,87, 82.65 ,85.26, 82.65 , 84.39 , 82.65 ,Current Medicare Rates,84.39,83.52,Included in per diem,82.65,Included in ER Case rate,82.65,82.65, 85.26 ,78.3
30010885,EAP,CPT® 86698,,0302 - LABORATORY - IMMUNOLOGY,Hc Histoplasma,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
30011405,EAP,CPT® 87385,,0302 - LABORATORY - IMMUNOLOGY,Hc Histoplasma Capsulatum Antigen,1,242, 229.90 ,237.16, 229.90 , 234.74 , 229.90 ,Current Medicare Rates,234.74,232.32,Included in per diem,229.9,Included in ER Case rate,229.9,229.9, 237.16 ,217.8
30010867,EAP,CPT® 86689,,0302 - LABORATORY - IMMUNOLOGY,Hc Hiv 1 Ab Confirm (arup),1,152, 144.40 ,148.96, 144.40 , 147.44 , 144.40 ,Current Medicare Rates,147.44,145.92,Included in per diem,144.4,Included in ER Case rate,144.4,144.4, 148.96 ,136.8
30210940,EAP,CPT® 86703,,0302 - LABORATORY - IMMUNOLOGY,Hc Hiv 1-2,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30210715,EAP,CPT® 86701,,0302 - LABORATORY - IMMUNOLOGY,Hc Hiv-1,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30010922,EAP,CPT® 86702,,0302 - LABORATORY - IMMUNOLOGY,HC HIV-2,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30011030,EAP,86812,,0302 - LABORATORY - IMMUNOLOGY,Hc Hla Typing A B Or C Single Antigen,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30010564,EAP,CPT® 86305,,0302 - LABORATORY - IMMUNOLOGY,Hc Human Epididymis Protein 4 - Ovarian,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30010589,EAP,CPT® 86332,,0302 - LABORATORY - IMMUNOLOGY,Hc Immune Complex Assay - C1q Binding,1,189, 179.55 ,185.22, 179.55 , 183.33 , 179.55 ,Current Medicare Rates,183.33,181.44,Included in per diem,179.55,Included in ER Case rate,179.55,179.55, 185.22 ,170.1
30010605,EAP,CPT® 86335,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunfix E-phorsis/urine/csf,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,Included in per diem,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
30210547,EAP,CPT® 86317,,0302 - LABORATORY - IMMUNOLOGY,"Hc Immunoassay Infectious Agent, Not Specified",1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
30010560,EAP,CPT® 86304,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunoassay Tumor Ca 125,1,186, 176.70 ,182.28, 176.70 , 180.42 , 176.70 ,Current Medicare Rates,180.42,178.56,Included in per diem,176.7,Included in ER Case rate,176.7,176.7, 182.28 ,167.4
30010492,EAP,CPT® 86300,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunoassay Tumor Ca 15-3,1,116, 110.20 ,113.68, 110.20 , 112.52 , 110.20 ,Current Medicare Rates,112.52,111.36,Included in per diem,110.2,Included in ER Case rate,110.2,110.2, 113.68 ,104.4
30010558,EAP,CPT® 86301,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunoassay Tumor Ca 19-9,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30010472,EAP,CPT® 86316,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunoassay Tumor Other - Chromogranin A,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
30010599,EAP,CPT® 86334,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunofix E-phoresis Serum,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30211079,EAP,CPT® 86335,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunofixation Urine,1,128, 121.60 ,125.44, 121.60 , 124.16 , 121.60 ,Current Medicare Rates,124.16,122.88,Included in per diem,121.6,Included in ER Case rate,121.6,121.6, 125.44 ,115.2
30211074,EAP,CPT® 86023,,0302 - LABORATORY - IMMUNOLOGY,Hc Immunoglobulin Assay - Igg,1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
30011698,EAP,CPT® 86336,,0302 - LABORATORY - IMMUNOLOGY,Hc Inhibin A,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30200110,EAP,86336,,0302 - LABORATORY - IMMUNOLOGY,HC INHIBIN A #,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30200120,EAP,86336,,0302 - LABORATORY - IMMUNOLOGY,HC INHIBIN A #,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30010617,EAP,CPT® 86337,,0302 - LABORATORY - IMMUNOLOGY,Hc Insulin Antibodies,1,93, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,Included in per diem,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
30210572,EAP,CPT® 86340,,0302 - LABORATORY - IMMUNOLOGY,Hc Intrinsic Factor Antibody,1,52, 49.40 ,50.96, 49.40 , 50.44 , 49.40 ,Current Medicare Rates,50.44,49.92,Included in per diem,49.4,Included in ER Case rate,49.4,49.4, 50.96 ,46.8
30010623,EAP,CPT® 86341,,0302 - LABORATORY - IMMUNOLOGY,HC ISLET CELL ANTIBODY,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30200117,EAP,86341,,0302 - LABORATORY - IMMUNOLOGY,HC ISLET CELL ANTIBODY #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30010936,EAP,CPT® 86713,,0302 - LABORATORY - IMMUNOLOGY,Hc Legionella Antibody,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30010939,EAP,CPT® 86720,,0302 - LABORATORY - IMMUNOLOGY,Hc Leptospira Antibody,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30010731,EAP,CPT® 86618,,0302 - LABORATORY - IMMUNOLOGY,Hc Lyme Disease Antibody,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30010722,EAP,86617,,0302 - LABORATORY - IMMUNOLOGY,Hc Lyme Disease Antibody Confirmation,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
30012170,EAP,CPT® 86617,,0302 - LABORATORY - IMMUNOLOGY,Hc Lyme Igg By Western Blot,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
30210741,EAP,CPT® 86727,,0302 - LABORATORY - IMMUNOLOGY,Hc Lymph Choriomeningitis Ab - Csf,1,49, 46.55 ,48.02, 46.55 , 47.53 , 46.55 ,Current Medicare Rates,47.53,47.04,Included in per diem,46.55,Included in ER Case rate,46.55,46.55, 48.02 ,44.1
30200114,EAP,86376,,0302 - LABORATORY - IMMUNOLOGY,HC MICROSOMAL ANTIBODIES EACH #,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30200152,EAP,86376,,0302 - LABORATORY - IMMUNOLOGY,HC MICROSOMAL ANTIBODIES EACH #,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30010663,EAP,CPT® 86376,,0302 - LABORATORY - IMMUNOLOGY,Hc Microsomal Antibody,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30010660,EAP,CPT® 86376,,0302 - LABORATORY - IMMUNOLOGY,Hc Microsomal Antibody -throid Peroxidase,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
30010679,EAP,CPT® 86356,,0302 - LABORATORY - IMMUNOLOGY,Hc Mononuclear Cell Antigen,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30210350,EAP,CPT® 86738,,0302 - LABORATORY - IMMUNOLOGY,Hc Mycoplasma Antibody,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30210925,EAP,CPT® 86171,,0302 - LABORATORY - IMMUNOLOGY,Hc Neisseria Gonorrhea Ab By Cf,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30011368,EAP,CPT® 86741,,0302 - LABORATORY - IMMUNOLOGY,Hc Neisseria Meningitidis,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30010641,EAP,CPT® 86357,,0302 - LABORATORY - IMMUNOLOGY,Hc Nk Cells Total Count,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30011469,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - 86235 Jo1,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30011488,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,HC Nuclear antigen antibody - ENA,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30210532,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Extractable Ag Ab,1,18, 17.10 ,17.64, 17.10 , 17.46 , 17.10 ,Current Medicare Rates,17.46,17.28,Included in per diem,17.1,Included in ER Case rate,17.1,17.1, 17.64 ,16.2
30210528,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Jo 1,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
30011493,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Ribosomal Protein,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
30211132,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Rnp,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
30210527,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Scl 70,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30210486,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Sm Rnp,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30210487,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Ssa,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30210534,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Nuclear Antigen Antibody - Ssb,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30010954,EAP,CPT® 86747,,0302 - LABORATORY - IMMUNOLOGY,Hc Parvovirus Igm (panl),1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30210923,EAP,CPT® 86078,,0302 - LABORATORY - IMMUNOLOGY,Hc Physician Blood Bank Service - Transfusion Reaction,1,353, 335.35 ,345.94, 335.35 , 342.41 , 335.35 ,Current Medicare Rates,342.41,338.88,Included in per diem,335.35,Included in ER Case rate,335.35,335.35, 345.94 ,317.7
30210346,EAP,CPT® 86022,,0302 - LABORATORY - IMMUNOLOGY,Hc Platelet Antibodies - Heparin,1,225, 213.75 ,220.5, 213.75 , 218.25 , 213.75 ,Current Medicare Rates,218.25,216,Included in per diem,213.75,Included in ER Case rate,213.75,213.75, 220.50 ,202.5
30210750,EAP,CPT® 86753,,0302 - LABORATORY - IMMUNOLOGY,Hc Protozoa Antibody Nos,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30010743,EAP,CPT® 86638,,0302 - LABORATORY - IMMUNOLOGY,Hc Q Fever Antibody,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,Included in per diem,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30210934,EAP,CPT® 86480,,0302 - LABORATORY - IMMUNOLOGY,Hc Quantiferon Tb Gold,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,Included in per diem,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
30011742,EAP,CPT® 86860,,0302 - LABORATORY - IMMUNOLOGY,Hc Rbc Antibody Elution,1,137, 130.15 ,134.26, 130.15 , 132.89 , 130.15 ,Current Medicare Rates,132.89,131.52,Included in per diem,130.15,Included in ER Case rate,130.15,130.15, 134.26 ,123.3
30011046,EAP,CPT® 86870,,0302 - LABORATORY - IMMUNOLOGY,Hc Rbc Antibody Identification,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30011040,EAP,CPT® 86850,,0302 - LABORATORY - IMMUNOLOGY,Hc Rbc Antibody Screen,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30011134,EAP,CPT® 86976,,0302 - LABORATORY - IMMUNOLOGY,Hc Rbc Pretreatment Serum - Dilution,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30211142,EAP,CPT® 86901,,0302 - LABORATORY - IMMUNOLOGY,HC RH TYPE,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30210522,EAP,CPT® 86431,,0302 - LABORATORY - IMMUNOLOGY,Hc Rheumatoid Factor Quant,1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
30210245,EAP,CPT® 86431,,0302 - LABORATORY - IMMUNOLOGY,Hc Rheumatoid Factor Quantitative #,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
30010675,EAP,CPT® 86430,,0302 - LABORATORY - IMMUNOLOGY,Hc Rheumatoid Factor Test,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30211505,EAP,CPT® 86593,,0302 - LABORATORY - IMMUNOLOGY,Hc Rpr Quantitative,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30210766,EAP,CPT® 86762,,0302 - LABORATORY - IMMUNOLOGY,Hc Rubella Antibody,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30017035,EAP,CPT® 86765,,0302 - LABORATORY - IMMUNOLOGY,Hc Rubeola Ab-igg,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30010975,EAP,CPT® 86765,,0302 - LABORATORY - IMMUNOLOGY,Hc Rubeola Antibody Igg Ab,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30210241,EAP,CPT® 86769,,0302 - LABORATORY - IMMUNOLOGY,HC SARS CoV-2 Immune Response IgG,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30011905,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Scl-70 Ab Igg(arup),1,18, 17.10 ,17.64, 17.10 , 17.46 , 17.10 ,Current Medicare Rates,17.46,17.28,Included in per diem,17.1,Included in ER Case rate,17.1,17.1, 17.64 ,16.2
30012126,EAP,CPT® 86235,,0302 - LABORATORY - IMMUNOLOGY,Hc Smrnp Autoantibody,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
30210608,EAP,CPT® 86592,,0302 - LABORATORY - IMMUNOLOGY,Hc Syphilis Test Non-trep Qual,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30210605,EAP,CPT® 86592,,0302 - LABORATORY - IMMUNOLOGY,Hc Syphilis Test Non-trep Qual,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30010657,EAP,CPT® 86361,,0302 - LABORATORY - IMMUNOLOGY,Hc T Cell Absolute Count,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30010648,EAP,CPT® 86360,,0302 - LABORATORY - IMMUNOLOGY,Hc T Cell Absolute Count/ratio,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30011868,EAP,CPT® 86359,,0302 - LABORATORY - IMMUNOLOGY,HC T CELLS TOTAL COUNT,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30012379,EAP,CPT® 86481,,0302 - LABORATORY - IMMUNOLOGY,Hc Tb Ag Response T-cell Susp,1,203, 192.85 ,198.94, 192.85 , 196.91 , 192.85 ,Current Medicare Rates,196.91,194.88,Included in per diem,192.85,Included in ER Case rate,192.85,192.85, 198.94 ,182.7
30010684,EAP,CPT® 86580,,0302 - LABORATORY - IMMUNOLOGY,Hc Tb Intradermal Test,1,31, 29.45 ,30.38, 29.45 , 30.07 , 29.45 ,Current Medicare Rates,30.07,29.76,Included in per diem,29.45,Included in ER Case rate,29.45,29.45, 30.38 ,27.9
30010478,EAP,CPT® 86800,,0302 - LABORATORY - IMMUNOLOGY,Hc Thyroglobulin Ab,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30210361,EAP,CPT® 86800,,0302 - LABORATORY - IMMUNOLOGY,Hc Thyroglobulin Antibody,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30011019,EAP,CPT® 86800,,0302 - LABORATORY - IMMUNOLOGY,Hc Thyroglobulin Antibody Screen,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,Included in per diem,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30010982,EAP,CPT® 86777,,0302 - LABORATORY - IMMUNOLOGY,Hc Toxoplasma Antibody,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30010990,EAP,CPT® 86778,,0302 - LABORATORY - IMMUNOLOGY,Hc Toxoplasma Antibody Igm,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
30010996,EAP,CPT® 86780,,0302 - LABORATORY - IMMUNOLOGY,Hc Treponema Pallidum,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30210360,EAP,CPT® 86780,,0302 - LABORATORY - IMMUNOLOGY,Hc Treponema Pallidum,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30011007,EAP,CPT® 86787,,0302 - LABORATORY - IMMUNOLOGY,Hc Varicella Zoster Ab Igg(pnl),1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
30011006,EAP,CPT® 86787,,0302 - LABORATORY - IMMUNOLOGY,Hc Varicella-zoster Antibody,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30210794,EAP,CPT® 86790,,0302 - LABORATORY - IMMUNOLOGY,Hc Virus Antibody Nos - Htlv-1,1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30210773,EAP,CPT® 86788,,0302 - LABORATORY - IMMUNOLOGY,Hc West Nile Virus Ab Igm,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30210776,EAP,CPT® 86789,,0302 - LABORATORY - IMMUNOLOGY,Hc West Nile Virus Antibody,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30010962,EAP,CPT® 86750,,0302 - LABORATORY - IMMUNOLOGY,Hc Z86750 Ref Lab,1,189, 179.55 ,185.22, 179.55 , 183.33 , 179.55 ,Current Medicare Rates,183.33,181.44,Included in per diem,179.55,Included in ER Case rate,179.55,179.55, 185.22 ,170.1
30010014,EAP,CPT® 86794,,0302 - LABORATORY - IMMUNOLOGY,Hc Zika Virus Igm Antibody,1,13, 12.35 ,12.74, 12.35 , 12.61 , 12.35 ,Current Medicare Rates,12.61,12.48,Included in per diem,12.35,Included in ER Case rate,12.35,12.35, 12.74 ,11.7
30500038,EAP,85670,,0305 - LABORATORY - HEMATOLOGY,HC THROMBIN TIME PLASMA #,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
30510084,EAP,CPT® 85307,,0305 - LABORATORY - HEMATOLOGY,Hc Apc Resistance Assay,1,143, 135.85 ,140.14, 135.85 , 138.71 , 135.85 ,Current Medicare Rates,138.71,137.28,Included in per diem,135.85,Included in ER Case rate,135.85,135.85, 140.14 ,128.7
30510047,EAP,CPT® 85004,,0305 - LABORATORY - HEMATOLOGY,Hc Automated Diff Wbc Count,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30510077,EAP,CPT® 85041,,0305 - LABORATORY - HEMATOLOGY,Hc Automated Rbc Count,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
30510040,EAP,CPT® 85250,,0305 - LABORATORY - HEMATOLOGY,Hc Blood Clot Factor Ix Test,1,144, 136.80 ,141.12, 136.80 , 139.68 , 136.80 ,Current Medicare Rates,139.68,138.24,Included in per diem,136.8,Included in ER Case rate,136.8,136.8, 141.12 ,129.6
30510072,EAP,CPT® 85240,,0305 - LABORATORY - HEMATOLOGY,Hc Blood Clot Factor Viii Test Factor,1,124, 117.80 ,121.52, 117.80 , 120.28 , 117.80 ,Current Medicare Rates,120.28,119.04,Included in per diem,117.8,Included in ER Case rate,117.8,117.8, 121.52 ,111.6
30510046,EAP,CPT® 85302,,0305 - LABORATORY - HEMATOLOGY,Hc Blood Clot Inhibitor Antigen,1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
30014447,EAP,CPT® 85027,,0305 - LABORATORY - HEMATOLOGY,Hc Blood Count Complete Automated,1,94, 89.30 ,92.12, 89.30 , 91.18 , 89.30 ,Current Medicare Rates,91.18,90.24,Included in per diem,89.3,Included in ER Case rate,89.3,89.3, 92.12 ,84.6
30014448,EAP,CPT® 85048,,0305 - LABORATORY - HEMATOLOGY,Hc Blood Count Leukocyte (wbc) Automated,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
30014514,EAP,CPT® 85025,,0305 - LABORATORY - HEMATOLOGY,Hc Cbc With Diff Auto,1,94, 89.30 ,92.12, 89.30 , 91.18 , 89.30 ,Current Medicare Rates,91.18,90.24,Included in per diem,89.3,Included in ER Case rate,89.3,89.3, 92.12 ,84.6
30510207,EAP,CPT® 85303,,0305 - LABORATORY - HEMATOLOGY,Hc Clotting Inhibitors Protein C Activity #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30510233,EAP,CPT® 85306,,0305 - LABORATORY - HEMATOLOGY,Hc Clotting Inhibitors Protein S Free #,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30510029,EAP,CPT® 85025,,0305 - LABORATORY - HEMATOLOGY,Hc Complete Cbc W/auto Diff Wbc,1,35, 33.25 ,34.3, 33.25 , 33.95 , 33.25 ,Current Medicare Rates,33.95,33.6,Included in per diem,33.25,Included in ER Case rate,33.25,33.25, 34.30 ,31.5
30014674,EAP,CPT® 85379,,0305 - LABORATORY - HEMATOLOGY,Hc Ddimer Quant,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
30012071,EAP,CPT® 85007,,0305 - LABORATORY - HEMATOLOGY,Hc Differential Manual,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30014828,EAP,CPT® 85247,,0305 - LABORATORY - HEMATOLOGY,Hc Factor 8 Multimeric Analysis,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30014848,EAP,CPT® 85230,,0305 - LABORATORY - HEMATOLOGY,Hc Factor Vii,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,Included in per diem,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30014867,EAP,CPT® 85270,,0305 - LABORATORY - HEMATOLOGY,Hc Factor Xi,1,163, 154.85 ,159.74, 154.85 , 158.11 , 154.85 ,Current Medicare Rates,158.11,156.48,Included in per diem,154.85,Included in ER Case rate,154.85,154.85, 159.74 ,146.7
30510069,EAP,CPT® 85379,,0305 - LABORATORY - HEMATOLOGY,Hc Fibrin Degradation Quant,1,47, 44.65 ,46.06, 44.65 , 45.59 , 44.65 ,Current Medicare Rates,45.59,45.12,Included in per diem,44.65,Included in ER Case rate,44.65,44.65, 46.06 ,42.3
30510080,EAP,CPT® 85378,,0305 - LABORATORY - HEMATOLOGY,Hc Fibrin Degrade Semiquant,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
30510063,EAP,CPT® 85384,,0305 - LABORATORY - HEMATOLOGY,Hc Fibrinogen,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30015080,EAP,CPT® 85018,,0305 - LABORATORY - HEMATOLOGY,Hc Hemoglobin (hgb),1,45, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,Included in per diem,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
30510038,EAP,CPT® 85520,,0305 - LABORATORY - HEMATOLOGY,Hc Heparin Assay,1,253, 240.35 ,247.94, 240.35 , 245.41 , 240.35 ,Current Medicare Rates,245.41,242.88,Included in per diem,240.35,Included in ER Case rate,240.35,240.35, 247.94 ,227.7
30015407,EAP,CPT® 85613,,0305 - LABORATORY - HEMATOLOGY,Hc Lup Anticoag-drvvt,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30015409,EAP,CPT® 85730,,0305 - LABORATORY - HEMATOLOGY,Hc Lupus Anticoag-ptt,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30510057,EAP,CPT® 85549,,0305 - LABORATORY - HEMATOLOGY,Hc Muramidase,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30510373,EAP,CPT® 85598,,0305 - LABORATORY - HEMATOLOGY,Hc Phospholipid Neutralization Hexagonal,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30015693,EAP,CPT® 85420,,0305 - LABORATORY - HEMATOLOGY,Hc Plasminogen Activity,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
30510082,EAP,CPT® 85049,,0305 - LABORATORY - HEMATOLOGY,Hc Platelet Count,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30510074,EAP,CPT® 85303,,0305 - LABORATORY - HEMATOLOGY,Hc Protein C Activity,1,95, 90.25 ,93.1, 90.25 , 92.15 , 90.25 ,Current Medicare Rates,92.15,91.2,Included in per diem,90.25,Included in ER Case rate,90.25,90.25, 93.10 ,85.5
30510071,EAP,CPT® 85306,,0305 - LABORATORY - HEMATOLOGY,Hc Protein S Activity,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,Included in per diem,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
30510231,EAP,CPT® 85305,,0305 - LABORATORY - HEMATOLOGY,"HC PROTEIN S, ANTIGEN",1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30510076,EAP,CPT® 85652,,0305 - LABORATORY - HEMATOLOGY,Hc Rbc Sed Rate Automated,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
30510027,EAP,CPT® 85651,,0305 - LABORATORY - HEMATOLOGY,Hc Rbc Sed Rate Nonautomated,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
30015882,EAP,CPT® 85045,,0305 - LABORATORY - HEMATOLOGY,Hc Retic Automated,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
30013969,EAP,CPT® 85046,,0305 - LABORATORY - HEMATOLOGY,Hc Reticyte/hgb Concentrate,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30013139,EAP,CPT® 85613,,0305 - LABORATORY - HEMATOLOGY,Hc Russell Viper Venom Diluted,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30510011,EAP,CPT® 85651,,0305 - LABORATORY - HEMATOLOGY,Hc Sedimentation Rate Rbc Non-automated #,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
30016030,EAP,CPT® 85300,,0305 - LABORATORY - HEMATOLOGY,Hc Thrombin Iii Activity,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30510050,EAP,CPT® 85670,,0305 - LABORATORY - HEMATOLOGY,Hc Thrombin Time,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,Included in per diem,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30510033,EAP,CPT® 85730,,0305 - LABORATORY - HEMATOLOGY,Hc Thromboplastin Time Partial,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30510094,EAP,CPT® 85612,,0305 - LABORATORY - HEMATOLOGY,Hc Viper Venom Prothrombin Time,1,198, 188.10 ,194.04, 188.10 , 192.06 , 188.10 ,Current Medicare Rates,192.06,190.08,Included in per diem,188.1,Included in ER Case rate,188.1,188.1, 194.04 ,178.2
30016212,EAP,CPT® 85240,,0305 - LABORATORY - HEMATOLOGY,Hc Vw Pan-factor Viii One Stage,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30016213,EAP,CPT® 85245,,0305 - LABORATORY - HEMATOLOGY,Hc Vw Pan-ristocetin Cofactor,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30016214,EAP,CPT® 85246,,0305 - LABORATORY - HEMATOLOGY,Hc Vw Pan-von Will Factor Ag,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30510048,EAP,CPT® 85540,,0305 - LABORATORY - HEMATOLOGY,Hc Wbc Alkaline Phosphatase,1,126, 119.70 ,123.48, 119.70 , 122.22 , 119.70 ,Current Medicare Rates,122.22,120.96,Included in per diem,119.7,Included in ER Case rate,119.7,119.7, 123.48 ,113.4
30510310,EAP,CPT® 85048,,0305 - LABORATORY - HEMATOLOGY,Hc Wbc Auto,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
30011540,EAP,87480,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC CANDIDA DNA DIRECT PROBE,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30600089,EAP,87811,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC SARS-COV-2 COVID19 W/OPTIC POCT #,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
30011799,EAP,87660,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC TRICHOMONAS VAG DNA PROBE(PANL),1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30600104,EAP,87255,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC #,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30600111,EAP,87255,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC #,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30011309,EAP,CPT® 87260,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Adenovirus Infectious Agent,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
30610665,EAP,CPT® 87206,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Afb Stain,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
30011418,EAP,CPT® 87476,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc B Burgdorferi Pcr (arup),1,123, 116.85 ,120.54, 116.85 , 119.31 , 116.85 ,Current Medicare Rates,119.31,118.08,Included in per diem,116.85,Included in ER Case rate,116.85,116.85, 120.54 ,110.7
30610966,EAP,CPT® 87471,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,"Hc Bartonella, Amplified Probe",1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
30011530,EAP,CPT® 87801,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Bordetella Pertussis Pcr,1,208, 197.60 ,203.84, 197.60 , 201.76 , 197.60 ,Current Medicare Rates,201.76,199.68,Included in per diem,197.6,Included in ER Case rate,197.6,197.6, 203.84 ,187.2
30610668,EAP,CPT® 87493,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc C Diff Pcr,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
30011532,EAP,CPT® 87493,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc C Diff Pcr2,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
30011169,EAP,CPT® 87110,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Chlamydia Culture,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30011573,EAP,CPT® 87491,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC CHLAMYDIA TRACHOMATIS AMPLIFIED DNA,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30011574,EAP,CPT® 87491,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Chlamydia Trachomatis Amplified Probe,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
30011572,EAP,CPT® 87491,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Chlamydia Trachomatis Pcr,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30610581,EAP,CPT® 87324,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Clostridium Ag Eia,1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,Included in per diem,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
30016255,EAP,CPT® 87493,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Clostridium Difficile Toxins Amplified Probe,1,131, 124.45 ,128.38, 124.45 , 127.07 , 124.45 ,Current Medicare Rates,127.07,125.76,Included in per diem,124.45,Included in ER Case rate,124.45,124.45, 128.38 ,117.9
30011582,EAP,CPT® 87497,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Cmv Quantitation,1,445, 422.75 ,436.1, 422.75 , 431.65 , 422.75 ,Current Medicare Rates,431.65,427.2,Included in per diem,422.75,Included in ER Case rate,422.75,422.75, 436.10 ,400.5
30600007,EAP,87426,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC CORONAVIRUS AG IA #,1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
30610482,EAP,CPT® 87635,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC COVID-19 AMP PRB IN HOUSE TESTING 87635,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30610236,EAP,HCPCS U0003,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC COVID-19 AMP PRB LABCORP,1,293, 278.35 ,287.14, 278.35 , 284.21 , 278.35 ,Current Medicare Rates,284.21,281.28,Included in per diem,278.35,Included in ER Case rate,278.35,278.35, 287.14 ,263.7
30610238,EAP,HCPCS U0003,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC COVID-19 AMP PRB QUEST,1,168, 159.60 ,164.64, 159.60 , 162.96 , 159.60 ,Current Medicare Rates,162.96,161.28,Included in per diem,159.6,Included in ER Case rate,159.6,159.6, 164.64 ,151.2
30011353,EAP,CPT® 87327,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Cryptococcus Neoform Ag Eia - Infectious,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,Included in per diem,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30011355,EAP,CPT® 87328,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Cryptosporidium Ag Eia,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30011159,EAP,CPT® 87075,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Cultr Bacteria Except Blood,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30610356,EAP,CPT® 87076,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Culture Anaerobe Ident Each,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30011966,EAP,CPT® 87070,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC CULTURE BACTERIA OTHER - ENVIRONMENTAL,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
30610606,EAP,CPT® 87046,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Culture Stool Additional Path,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
30610463,EAP,CPT® 87147,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Culture Type Immunologic,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
30610971,EAP,CPT® 87483,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Dna Probe Type 12-25,1,1703," 1,617.85 ",1668.94," 1,617.85 "," 1,651.91 "," 1,617.85 ",Current Medicare Rates,1651.91,1634.88,Included in per diem,1617.85,Included in ER Case rate,1617.85,1617.85," 1,668.94 ",1532.7
30011613,EAP,CPT® 87799,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Epstein Barr Virus Quant Pcr,1,240, 228.00 ,235.2, 228.00 , 232.80 , 228.00 ,Current Medicare Rates,232.8,230.4,Included in per diem,228,Included in ER Case rate,228,228, 235.20 ,216
30010068,EAP,CPT® 87631,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC FLU A FLU B AND RSV BY PCR,1,580, 551.00 ,568.4, 551.00 , 562.60 , 551.00 ,Current Medicare Rates,562.6,556.8,Included in per diem,551,Included in ER Case rate,551,551, 568.40 ,522
30011637,EAP,87510,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC GARDNER VAG DNA DIRECT PROBE,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30011308,EAP,CPT® 87255,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Genet Virus Isolate Hsv,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,Included in per diem,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30610583,EAP,CPT® 87329,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Giardia Antigen,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30610663,EAP,CPT® 87338,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc H Pylori Antigen Stool,1,130, 123.50 ,127.4, 123.50 , 126.10 , 123.50 ,Current Medicare Rates,126.1,124.8,Included in per diem,123.5,Included in ER Case rate,123.5,123.5, 127.40 ,117
30610698,EAP,CPT® 87517,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Hepatitis B Dna Quantification,1,211, 200.45 ,206.78, 200.45 , 204.67 , 200.45 ,Current Medicare Rates,204.67,202.56,Included in per diem,200.45,Included in ER Case rate,200.45,200.45, 206.78 ,189.9
30011646,EAP,CPT® 87340,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Hepatitis B Surface Antigen,1,45, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,Included in per diem,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
30011394,EAP,CPT® 87350,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Hepatitis Be Antigen (arup),1,53, 50.35 ,51.94, 50.35 , 51.41 , 50.35 ,Current Medicare Rates,51.41,50.88,Included in per diem,50.35,Included in ER Case rate,50.35,50.35, 51.94 ,47.7
30011397,EAP,CPT® 87350,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Hepatitis Be Antigen (hbeag),1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
30610103,EAP,CPT® 87522,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Hepatitis C Quantitative Pcr,1,310, 294.50 ,303.8, 294.50 , 300.70 , 294.50 ,Current Medicare Rates,300.7,297.6,Included in per diem,294.5,Included in ER Case rate,294.5,294.5, 303.80 ,279
30011653,EAP,CPT® 87522,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Hepatitis C Quantitative Pcr Paml,1,310, 294.50 ,303.8, 294.50 , 300.70 , 294.50 ,Current Medicare Rates,300.7,297.6,Included in per diem,294.5,Included in ER Case rate,294.5,294.5, 303.80 ,279
30011655,EAP,CPT® 87522,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Hepatitis C Rna Quantification,1,297, 282.15 ,291.06, 282.15 , 288.09 , 282.15 ,Current Medicare Rates,288.09,285.12,Included in per diem,282.15,Included in ER Case rate,282.15,282.15, 291.06 ,267.3
30610199,EAP,CPT® 87385,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Iaad Ia Histoplasm Capsulatum #,1,268, 254.60 ,262.64, 254.60 , 259.96 , 254.60 ,Current Medicare Rates,259.96,257.28,Included in per diem,254.6,Included in ER Case rate,254.6,254.6, 262.64 ,241.2
30610178,EAP,CPT® 87449,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Iaad Ia Mult Step Method Nos Each Organism,1,73, 69.35 ,71.54, 69.35 , 70.81 , 69.35 ,Current Medicare Rates,70.81,70.08,Included in per diem,69.35,Included in ER Case rate,69.35,69.35, 71.54 ,65.7
30600109,EAP,87491,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ #,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30610191,EAP,CPT® 87491,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Iadna Chlamydia Trachomatis Amplified Probe Tq #,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,Included in per diem,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30010015,EAP,87634,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE #,1,287, 272.65 ,281.26, 272.65 , 278.39 , 272.65 ,Current Medicare Rates,278.39,275.52,Included in per diem,272.65,Included in ER Case rate,272.65,272.65, 281.26 ,258.3
30600106,EAP,87591,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ #,1,81, 76.95 ,79.38, 76.95 , 78.57 , 76.95 ,Current Medicare Rates,78.57,77.76,Included in per diem,76.95,Included in ER Case rate,76.95,76.95, 79.38 ,72.9
30600108,EAP,87591,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ #,1,81, 76.95 ,79.38, 76.95 , 78.57 , 76.95 ,Current Medicare Rates,78.57,77.76,Included in per diem,76.95,Included in ER Case rate,76.95,76.95, 79.38 ,72.9
30600106,EAP,87591,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ #,1,81, 76.95 ,79.38, 76.95 , 78.57 , 76.95 ,Current Medicare Rates,78.57,77.76,Included in per diem,76.95,Included in ER Case rate,76.95,76.95, 79.38 ,72.9
30600108,EAP,87591,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ #,1,81, 76.95 ,79.38, 76.95 , 78.57 , 76.95 ,Current Medicare Rates,78.57,77.76,Included in per diem,76.95,Included in ER Case rate,76.95,76.95, 79.38 ,72.9
30610194,EAP,CPT® 87591,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Iadna Neisseria Gonorrhoeae Amplified Probe Tq #,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30010260,EAP,CPT® 87631,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Iadna Respiratry Probe & Rev Trnscr 3-5 Targets,1,275, 261.25 ,269.5, 261.25 , 266.75 , 261.25 ,Current Medicare Rates,266.75,264,Included in per diem,261.25,Included in ER Case rate,261.25,261.25, 269.50 ,247.5
30610185,EAP,87640,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC IADNA S AUREUS AMPLIFIED PROBE TQ,1,111, 105.45 ,108.78, 105.45 , 107.67 , 105.45 ,Current Medicare Rates,107.67,106.56,Included in per diem,105.45,Included in ER Case rate,105.45,105.45, 108.78 ,99.9
30011321,EAP,CPT® 87276,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Influenza A Ag If,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
30011318,EAP,CPT® 87275,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Influenza B Ag If,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
30011697,EAP,CPT® 87804,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Influenza Screen,1,121, 114.95 ,118.58, 114.95 , 117.37 , 114.95 ,Current Medicare Rates,117.37,116.16,Included in per diem,114.95,Included in ER Case rate,114.95,114.95, 118.58 ,108.9
30015358,EAP,CPT® 83630,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Lactoferrin Fecal Qualitative,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30011703,EAP,CPT® 87899,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Legionella Antigen Urine,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
30011710,EAP,CPT® 87581,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc M.pneumon Dna Amplified Probe,1,246, 233.70 ,241.08, 233.70 , 238.62 , 233.70 ,Current Medicare Rates,238.62,236.16,Included in per diem,233.7,Included in ER Case rate,233.7,233.7, 241.08 ,221.4
30011197,EAP,CPT® 87169,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Macroscopic Exam Parasite,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30610483,EAP,CPT® 87181,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Microbe Susceptible Diffuse,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,Included in per diem,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
30610491,EAP,CPT® 87184,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Microbe Susceptible Disk,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
30610551,EAP,CPT® 87185,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Microbe Susceptible Enzyme,1,13, 12.35 ,12.74, 12.35 , 12.61 , 12.35 ,Current Medicare Rates,12.61,12.48,Included in per diem,12.35,Included in ER Case rate,12.35,12.35, 12.74 ,11.7
30610449,EAP,CPT® 87116,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Mycobacteria Culture - Afb Culture_1,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30011168,EAP,CPT® 87109,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Mycoplasma Pneumo Cult,1,64, 60.80 ,62.72, 60.80 , 62.08 , 60.80 ,Current Medicare Rates,62.08,61.44,Included in per diem,60.8,Included in ER Case rate,60.8,60.8, 62.72 ,57.6
30610129,EAP,CPT® 87591,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC N.GONORRHOEAE DNA AMPLIFIED PROBE,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
30011200,EAP,CPT® 87177,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,HC OVA AND PARASITES SMEARS,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30011326,EAP,CPT® 87279,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Parainfluenza Ag If,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
30011311,EAP,CPT® 87265,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Pertussis Ag If,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
30610477,EAP,CPT® 87172,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Pinworm Exam,1,19, 18.05 ,18.62, 18.05 , 18.43 , 18.05 ,Current Medicare Rates,18.43,18.24,Included in per diem,18.05,Included in ER Case rate,18.05,18.05, 18.62 ,17.1
30011741,EAP,CPT® 87880,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Rapid Strep Screen,1,45, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,Included in per diem,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
30011328,EAP,CPT® 87280,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Respiratory Syncytial Ag If,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
30610142,EAP,CPT® 87425,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Rotavirus Antigen Detection,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,Included in per diem,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30610144,EAP,CPT® 87807,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Rsv Direct Antigen,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,Included in per diem,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30011756,EAP,CPT® 87899,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Shigatoxin 2,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
30011257,EAP,CPT® 87209,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Smear Complex Stain-trichrome/ova/para,1,52, 49.40 ,50.96, 49.40 , 50.44 , 49.40 ,Current Medicare Rates,50.44,49.92,Included in per diem,49.4,Included in ER Case rate,49.4,49.4, 50.96 ,46.8
30011226,EAP,CPT® 87206,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Smear Fluorescent/acid Stai,1,28, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
30011248,EAP,CPT® 87207,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Smear Special Stain - Malaria Smear,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,Included in per diem,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30011260,EAP,CPT® 87210,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Smear Wet Mount Saline/ink - Koh Exam,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
30610599,EAP,CPT® 87015,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Specimen Conc,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,Included in per diem,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
30011141,EAP,CPT® 87015,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Specimen Concentration,1,25, 23.75 ,24.5, 23.75 , 24.25 , 23.75 ,Current Medicare Rates,24.25,24,Included in per diem,23.75,Included in ER Case rate,23.75,23.75, 24.50 ,22.5
30610056,EAP,CPT® 87651,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,"Hc Strep A Dna Probe, Amplification",1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
30010093,EAP,CPT® 87661,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Trichomonas Vaginalis Amplif,1,175, 166.25 ,171.5, 166.25 , 169.75 , 166.25 ,Current Medicare Rates,169.75,168,Included in per diem,166.25,Included in ER Case rate,166.25,166.25, 171.50 ,157.5
30610636,EAP,CPT® 87088,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Urine-iso-id,1,20, 19.00 ,19.6, 19.00 , 19.40 , 19.00 ,Current Medicare Rates,19.4,19.2,Included in per diem,19,Included in ER Case rate,19,19, 19.60 ,18
30011337,EAP,CPT® 87290,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Varicella Zoster Ag If,1,165, 156.75 ,161.7, 156.75 , 160.05 , 156.75 ,Current Medicare Rates,160.05,158.4,Included in per diem,156.75,Included in ER Case rate,156.75,156.75, 161.70 ,148.5
30011280,EAP,CPT® 87252,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Virus Inoculation Tissue,1,150, 142.50 ,147, 142.50 , 145.50 , 142.50 ,Current Medicare Rates,145.5,144,Included in per diem,142.5,Included in ER Case rate,142.5,142.5, 147.00 ,135
30011261,EAP,CPT® 87210,,0306 - LABORATORY - BACTERIOLOGY AND MICROBIOLOGY,Hc Wet Mount,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
30710010,EAP,CPT® 81015,,0307 - LABORATORY - UROLOGY,Hc Microscopic Exam Of Urine,1,16, 15.20 ,15.68, 15.20 , 15.52 , 15.20 ,Current Medicare Rates,15.52,15.36,Included in per diem,15.2,Included in ER Case rate,15.2,15.2, 15.68 ,14.4
30710102,EAP,CPT® 89320,,0307 - LABORATORY - UROLOGY,Hc Semen Analysis,1,158, 150.10 ,154.84, 150.10 , 153.26 , 150.10 ,Current Medicare Rates,153.26,151.68,Included in per diem,150.1,Included in ER Case rate,150.1,150.1, 154.84 ,142.2
30710008,EAP,CPT® 81003,,0307 - LABORATORY - UROLOGY,Hc Urinalysis Auto W/o Scope,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,Included in per diem,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
30710009,EAP,CPT® 81001,,0307 - LABORATORY - UROLOGY,Hc Urinalysis Auto W/scope,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30013017,EAP,CPT® 81050,,0307 - LABORATORY - UROLOGY,Hc Urinalysis Volume Measure,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,Included in per diem,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
30013001,EAP,CPT® 81025,,0307 - LABORATORY - UROLOGY,Hc Urine Pregnancy Test,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,Included in per diem,38,Included in ER Case rate,38,38, 39.20 ,36
31010710,EAP,81413,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,HC CAR ION CHNNL INCL 10 GNS,1,2743," 2,605.85 ",2688.14," 2,605.85 "," 2,660.71 "," 2,605.85 ",Current Medicare Rates,2660.71,2633.28,Included in per diem,2605.85,Included in ER Case rate,2605.85,2605.85," 2,688.14 ",2468.7
31010711,EAP,81414,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,HC CAR ION CHNNL INCL 2 GNS,1,2743," 2,605.85 ",2688.14," 2,605.85 "," 2,660.71 "," 2,605.85 ",Current Medicare Rates,2660.71,2633.28,Included in per diem,2605.85,Included in ER Case rate,2605.85,2605.85," 2,688.14 ",2468.7
30010266,EAP,CPT® 81206,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,HC BCR/ABL TRANSLOCATION MAJOR BREAKPOINT,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
30012263,EAP,CPT® 81206,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Bcr/abl Translocation Major Breakpoint (arup),1,747, 709.65 ,732.06, 709.65 , 724.59 , 709.65 ,Current Medicare Rates,724.59,717.12,Included in per diem,709.65,Included in ER Case rate,709.65,709.65, 732.06 ,672.3
30010271,EAP,CPT® 81207,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,HC BCR/ABL TRANSLOCATION MINOR BREAKPOINT,1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
30010002,EAP,CPT® 81207,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Bcr/abl1 Minor Breakpnt Qualitative/quantitative,1,667, 633.65 ,653.66, 633.65 , 646.99 , 633.65 ,Current Medicare Rates,646.99,640.32,Included in per diem,633.65,Included in ER Case rate,633.65,633.65, 653.66 ,600.3
31010217,EAP,CPT® 88368,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Bill Surg Her2neu By Fish,1,348, 330.60 ,341.04, 330.60 , 337.56 , 330.60 ,Current Medicare Rates,337.56,334.08,Included in per diem,330.6,Included in ER Case rate,330.6,330.6, 341.04 ,313.2
31010232,EAP,CPT® 88300,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Bill Surg Level 1,1,58, 55.10 ,56.84, 55.10 , 56.26 , 55.10 ,Current Medicare Rates,56.26,55.68,Included in per diem,55.1,Included in ER Case rate,55.1,55.1, 56.84 ,52.2
30010274,EAP,CPT® 81226,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Cyp2d6 Gene Analysis,1,820, 779.00 ,803.6, 779.00 , 795.40 , 779.00 ,Current Medicare Rates,795.4,787.2,Included in per diem,779,Included in ER Case rate,779,779, 803.60 ,738
31010606,EAP,CPT® 81229,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Cytogen M Array Copy No & Snp,1,3049," 2,896.55 ",2988.02," 2,896.55 "," 2,957.53 "," 2,896.55 ",Current Medicare Rates,2957.53,2927.04,Included in per diem,2896.55,Included in ER Case rate,2896.55,2896.55," 2,988.02 ",2744.1
31010341,EAP,CPT® 88311,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Decalcification,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
30010272,EAP,CPT® 81241,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,HC FACTOR V LEIDEN GENE ANALYSIS,1,218, 207.10 ,213.64, 207.10 , 211.46 , 207.10 ,Current Medicare Rates,211.46,209.28,Included in per diem,207.1,Included in ER Case rate,207.1,207.1, 213.64 ,196.2
30010279,EAP,CPT® 81256,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Hereditary Hemochromatosis Gene Analysis,1,160, 152.00 ,156.8, 152.00 , 155.20 , 152.00 ,Current Medicare Rates,155.2,153.6,Included in per diem,152,Included in ER Case rate,152,152, 156.80 ,144
31010720,EAP,88350,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,HC IMMUNOFLUORESCENCE PER SPEC ADD SINGL ANTB STAIN #,1,255, 242.25 ,249.9, 242.25 , 247.35 , 242.25 ,Current Medicare Rates,247.35,244.8,Included in per diem,242.25,Included in ER Case rate,242.25,242.25, 249.90 ,229.5
31010379,EAP,CPT® 88346,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,"HC IMMUNOFLUORESCENT STUDY, EACH ANTIBODY",1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
31010667,EAP,CPT® 88341,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Immunohisto Antibody Slide Ea Addl,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
31010386,EAP,CPT® 88342,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Immunohistochemistry Ea Antibody,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
31010391,EAP,CPT® 88365,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc In Situ Hybridization,1,241, 228.95 ,236.18, 228.95 , 233.77 , 228.95 ,Current Medicare Rates,233.77,231.36,Included in per diem,228.95,Included in ER Case rate,228.95,228.95, 236.18 ,216.9
31010180,EAP,CPT® 88364,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Insitu Hybridization Each Addl - Sendout,1,175, 166.25 ,171.5, 166.25 , 169.75 , 166.25 ,Current Medicare Rates,169.75,168,Included in per diem,166.25,Included in ER Case rate,166.25,166.25, 171.50 ,157.5
30010269,EAP,CPT® 81270,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,HC JAK2 V617F GENE ANALYSIS,1,541, 513.95 ,530.18, 513.95 , 524.77 , 513.95 ,Current Medicare Rates,524.77,519.36,Included in per diem,513.95,Included in ER Case rate,513.95,513.95, 530.18 ,486.9
31010674,EAP,CPT® 88377,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc M/phmtrc Alys Ishquant/semiq Manual Ea Multiplex,1,1375," 1,306.25 ",1347.5," 1,306.25 "," 1,333.75 "," 1,306.25 ",Current Medicare Rates,1333.75,1320,Included in per diem,1306.25,Included in ER Case rate,1306.25,1306.25," 1,347.50 ",1237.5
31010429,EAP,CPT® 88323,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Microslide Consultation W/ Slide Prep,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
31010608,EAP,CPT® 81401,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Molecular Path Level 2,1,475, 451.25 ,465.5, 451.25 , 460.75 , 451.25 ,Current Medicare Rates,460.75,456,Included in per diem,451.25,Included in ER Case rate,451.25,451.25, 465.50 ,427.5
31010140,EAP,CPT® 81405,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Mopath Procedure Level 6,1,1025, 973.75 ,1004.5, 973.75 , 994.25 , 973.75 ,Current Medicare Rates,994.25,984,Included in per diem,973.75,Included in ER Case rate,973.75,973.75," 1,004.50 ",922.5
30010270,EAP,CPT® 81291,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Mthfr Gene Analysis,1,205, 194.75 ,200.9, 194.75 , 198.85 , 194.75 ,Current Medicare Rates,198.85,196.8,Included in per diem,194.75,Included in ER Case rate,194.75,194.75, 200.90 ,184.5
30010267,EAP,CPT® 81240,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Prothrombin G20210a Gene Analysis,1,240, 228.00 ,235.2, 228.00 , 232.80 , 228.00 ,Current Medicare Rates,232.8,230.4,Included in per diem,228,Included in ER Case rate,228,228, 235.20 ,216
30010044,EAP,CPT® 81331,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Snrpn Ube3a Methylation Analysis,1,188, 178.60 ,184.24, 178.60 , 182.36 , 178.60 ,Current Medicare Rates,182.36,180.48,Included in per diem,178.6,Included in ER Case rate,178.6,178.6, 184.24 ,169.2
31010498,EAP,CPT® 88312,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Special Stain Group 1,1,175, 166.25 ,171.5, 166.25 , 169.75 , 166.25 ,Current Medicare Rates,169.75,168,Included in per diem,166.25,Included in ER Case rate,166.25,166.25, 171.50 ,157.5
31010500,EAP,CPT® 88313,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,Hc Special Stain Group 2,1,150, 142.50 ,147, 142.50 , 145.50 , 142.50 ,Current Medicare Rates,145.5,144,Included in per diem,142.5,Included in ER Case rate,142.5,142.5, 147.00 ,135
31010520,EAP,CPT® 88302,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,"Hc Surgical Path Gross/micro, Level 2",1,145, 137.75 ,142.1, 137.75 , 140.65 , 137.75 ,Current Medicare Rates,140.65,139.2,Included in per diem,137.75,Included in ER Case rate,137.75,137.75, 142.10 ,130.5
31010522,EAP,CPT® 88304,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,"Hc Surgical Path Gross/micro, Level 3",1,175, 166.25 ,171.5, 166.25 , 169.75 , 166.25 ,Current Medicare Rates,169.75,168,Included in per diem,166.25,Included in ER Case rate,166.25,166.25, 171.50 ,157.5
31010524,EAP,CPT® 88305,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,"Hc Surgical Path Gross/micro, Level 4",1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,Included in per diem,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
31010531,EAP,CPT® 88307,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,"Hc Surgical Path Gross/micro, Level 5",1,425, 403.75 ,416.5, 403.75 , 412.25 , 403.75 ,Current Medicare Rates,412.25,408,Included in per diem,403.75,Included in ER Case rate,403.75,403.75, 416.50 ,382.5
31010536,EAP,CPT® 88309,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,"Hc Surgical Path Gross/micro, Level 6",1,500, 475.00 ,490, 475.00 , 485.00 , 475.00 ,Current Medicare Rates,485,480,Included in per diem,475,Included in ER Case rate,475,475, 490.00 ,450
31010566,EAP,CPT® 88360,,0310 - LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION,"Hc Tumor Immunohistochemistry; Manual, Each Antibody",1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
31010281,EAP,CPT® 88262,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Chromosome Analysis 15-20 Cells; 2 Karatypes,1,197, 187.15 ,193.06, 187.15 , 191.09 , 187.15 ,Current Medicare Rates,191.09,189.12,Included in per diem,187.15,Included in ER Case rate,187.15,187.15, 193.06 ,177.3
31010318,EAP,CPT® 88291,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Cytogenetics/molecular Cytogenetics; Interp And Report,1,197, 187.15 ,193.06, 187.15 , 191.09 , 187.15 ,Current Medicare Rates,191.09,189.12,Included in per diem,187.15,Included in ER Case rate,187.15,187.15, 193.06 ,177.3
31010325,EAP,CPT® 88112,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Cytopath Cell Enhancement W/ Interp,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,Included in per diem,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30011594,EAP,CPT® 88175,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Cytopath Cerv/vag In Fluid; Auto Prep Manual Redo,1,45, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,Included in per diem,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
31010330,EAP,CPT® 88173,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Cytopath Eval Fine Needle Aspiration Interp/report,1,140, 133.00 ,137.2, 133.00 , 135.80 , 133.00 ,Current Medicare Rates,135.8,134.4,Included in per diem,133,Included in ER Case rate,133,133, 137.20 ,126
31010339,EAP,CPT® 88108,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Cytopath Smear/concentrate/interp; Tech,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
30011621,EAP,CPT® 88185,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,HC FLOW CYTOMETRY ADD MARKER,1,45, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,Included in per diem,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
30011626,EAP,CPT® 88184,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,HC FLOW CYTOMETRY FIRST MARKER,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
31010403,EAP,CPT® 88275,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Ish Analyze 100-300 Cells,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,Included in per diem,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
31010443,EAP,CPT® 88271,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,"Hc Molecular Cytogenetics Dna Probe, Each",1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
31110033,EAP,CPT® 88142,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Pap-thin Prep Screening,1,45, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,Included in per diem,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
31010546,EAP,CPT® 88230,,0311 - LABORATORY PATHOLOGICAL - CYTOLOGY,Hc Tissue Culture Lymphocyte,1,197, 187.15 ,193.06, 187.15 , 191.09 , 187.15 ,Current Medicare Rates,191.09,189.12,Included in per diem,187.15,Included in ER Case rate,187.15,187.15, 193.06 ,177.3
32010312,EAP,CPT® 75989,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Abscess Drainage W Img Guidance,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
32010345,EAP,CPT® 77081,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Bone Density Peripheral Skeleton,1,326, 309.70 ,319.48, 309.70 , 316.22 , 309.70 ,Current Medicare Rates,316.22,312.96,Included in per diem,309.7,Included in ER Case rate,309.7,309.7, 319.48 ,293.4
32010344,EAP,CPT® 77080,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Dxa Bone Density Axial,1,475, 451.25 ,465.5, 451.25 , 460.75 , 451.25 ,Current Medicare Rates,460.75,456,Included in per diem,451.25,Included in ER Case rate,451.25,451.25, 465.50 ,427.5
32010330,EAP,CPT® 77001,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Fluoro Central Venous Access Dev Placement,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010331,EAP,CPT® 77002,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC FLUORO LOC FOR NDL BX/ASPIR,1,421, 399.95 ,412.58, 399.95 , 408.37 , 399.95 ,Current Medicare Rates,408.37,404.16,Included in per diem,399.95,Included in ER Case rate,399.95,399.95, 412.58 ,378.9
32010318,EAP,CPT® 76000,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Fluoroscopy < 1 Hr,1,453, 430.35 ,443.94, 430.35 , 439.41 , 430.35 ,Current Medicare Rates,439.41,434.88,Included in per diem,430.35,Included in ER Case rate,430.35,430.35, 443.94 ,407.7
32010465,EAP,CPT® 76499,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Radiology Unlisted Procedure,1,894, 849.30 ,876.12, 849.30 , 867.18 , 849.30 ,Current Medicare Rates,867.18,858.24,Included in per diem,849.3,Included in ER Case rate,849.3,849.3, 876.12 ,804.6
32010211,EAP,CPT® 74420,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Urography Retrograde,1,752, 714.40 ,736.96, 714.40 , 729.44 , 714.40 ,Current Medicare Rates,729.44,721.92,Included in per diem,714.4,Included in ER Case rate,714.4,714.4, 736.96 ,676.8
32010190,EAP,CPT® 74018,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Abdomen Portable 1 View,1,293, 278.35 ,287.14, 278.35 , 284.21 , 278.35 ,Current Medicare Rates,284.21,281.28,Included in per diem,278.35,Included in ER Case rate,278.35,278.35, 287.14 ,263.7
32010175,EAP,CPT® 74022,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Abdomen Series,1,595, 565.25 ,583.1, 565.25 , 577.15 , 565.25 ,Current Medicare Rates,577.15,571.2,Included in per diem,565.25,Included in ER Case rate,565.25,565.25, 583.10 ,535.5
32010163,EAP,CPT® 73600,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Ankle 2 Views,1,256, 243.20 ,250.88, 243.20 , 248.32 , 243.20 ,Current Medicare Rates,248.32,245.76,Included in per diem,243.2,Included in ER Case rate,243.2,243.2, 250.88 ,230.4
32010165,EAP,CPT® 73610,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Ankle 3 Views,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32010115,EAP,CPT® 73092,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Arm Infant,1,204, 193.80 ,199.92, 193.80 , 197.88 , 193.80 ,Current Medicare Rates,197.88,195.84,Included in per diem,193.8,Included in ER Case rate,193.8,193.8, 199.92 ,183.6
32010111,EAP,CPT® 73085,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Arthrogram Of Elbow,1,1231," 1,169.45 ",1206.38," 1,169.45 "," 1,194.07 "," 1,169.45 ",Current Medicare Rates,1194.07,1181.76,Included in per diem,1169.45,Included in ER Case rate,1169.45,1169.45," 1,206.38 ",1107.9
32010196,EAP,CPT® 74300,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Bile Ducts/pancreas Intraop,1,469, 445.55 ,459.62, 445.55 , 454.93 , 445.55 ,Current Medicare Rates,454.93,450.24,Included in per diem,445.55,Included in ER Case rate,445.55,445.55, 459.62 ,422.1
32010338,EAP,CPT® 77072,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Bone Age Study,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32010039,EAP,CPT® 77073,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Bone Length Study,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32010341,EAP,CPT® 77075,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Bone Survey Complete,1,625, 593.75 ,612.5, 593.75 , 606.25 , 593.75 ,Current Medicare Rates,606.25,600,Included in per diem,593.75,Included in ER Case rate,593.75,593.75, 612.50 ,562.5
32010056,EAP,CPT® 72050,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Cervical Spine 4 Or 5 Views,1,488, 463.60 ,478.24, 463.60 , 473.36 , 463.60 ,Current Medicare Rates,473.36,468.48,Included in per diem,463.6,Included in ER Case rate,463.6,463.6, 478.24 ,439.2
32010057,EAP,CPT® 72052,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Cervical Spine 6 Or More Views,1,507, 481.65 ,496.86, 481.65 , 491.79 , 481.65 ,Current Medicare Rates,491.79,486.72,Included in per diem,481.65,Included in ER Case rate,481.65,481.65, 496.86 ,456.3
32010055,EAP,CPT® 72040,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC XR CERVICAL SPINE LESS THAN 3 VIEWS,1,337, 320.15 ,330.26, 320.15 , 326.89 , 320.15 ,Current Medicare Rates,326.89,323.52,Included in per diem,320.15,Included in ER Case rate,320.15,320.15, 330.26 ,303.3
32010085,EAP,CPT® 73000,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC XR CLAVICLE  UNILAT,1,290, 275.50 ,284.2, 275.50 , 281.30 , 275.50 ,Current Medicare Rates,281.3,278.4,Included in per diem,275.5,Included in ER Case rate,275.5,275.5, 284.20 ,261
32010213,EAP,CPT® 74430,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Contrast Bladder,1,424, 402.80 ,415.52, 402.80 , 411.28 , 402.80 ,Current Medicare Rates,411.28,407.04,Included in per diem,402.8,Included in ER Case rate,402.8,402.8, 415.52 ,381.6
32010097,EAP,CPT® 73040,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC XR CONTRAST SHOULDER,1,723, 686.85 ,708.54, 686.85 , 701.31 , 686.85 ,Current Medicare Rates,701.31,694.08,Included in per diem,686.85,Included in ER Case rate,686.85,686.85, 708.54 ,650.7
32010122,EAP,CPT® 73115,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Contrast Wrist,1,1174," 1,115.30 ",1150.52," 1,115.30 "," 1,138.78 "," 1,115.30 ",Current Medicare Rates,1138.78,1127.04,Included in per diem,1115.3,Included in ER Case rate,1115.3,1115.3," 1,150.52 ",1056.6
32010105,EAP,CPT® 73070,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Elbow 2 View,1,340, 323.00 ,333.2, 323.00 , 329.80 , 323.00 ,Current Medicare Rates,329.8,326.4,Included in per diem,323,Included in ER Case rate,323,323, 333.20 ,306
32010106,EAP,CPT® 73080,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Elbow 3 Views,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32010604,EAP,CPT® 72081,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Entire Spine 1 Vw,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
32010605,EAP,CPT® 72082,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Entire Spine 2-3 Vw,1,560, 532.00 ,548.8, 532.00 , 543.20 , 532.00 ,Current Medicare Rates,543.2,537.6,Included in per diem,532,Included in ER Case rate,532,532, 548.80 ,504
32010606,EAP,CPT® 72083,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Entire Spine 4-5 Vw,1,587, 557.65 ,575.26, 557.65 , 569.39 , 557.65 ,Current Medicare Rates,569.39,563.52,Included in per diem,557.65,Included in ER Case rate,557.65,557.65, 575.26 ,528.3
32010607,EAP,CPT® 72084,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Entire Spine 6/> Vw,1,735, 698.25 ,720.3, 698.25 , 712.95 , 698.25 ,Current Medicare Rates,712.95,705.6,Included in per diem,698.25,Included in ER Case rate,698.25,698.25, 720.30 ,661.5
32010041,EAP,CPT® 74220,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Esophagus Contrast,1,470, 446.50 ,460.6, 446.50 , 455.90 , 446.50 ,Current Medicare Rates,455.9,451.2,Included in per diem,446.5,Included in ER Case rate,446.5,446.5, 460.60 ,423
32010029,EAP,CPT® 74018,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Exam Abdomen 1 View,1,293, 278.35 ,287.14, 278.35 , 284.21 , 278.35 ,Current Medicare Rates,284.21,281.28,Included in per diem,278.35,Included in ER Case rate,278.35,278.35, 287.14 ,263.7
32010107,EAP,CPT® 74019,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Exam Abdomen 2 Views,1,390, 370.50 ,382.2, 370.50 , 378.30 , 370.50 ,Current Medicare Rates,378.3,374.4,Included in per diem,370.5,Included in ER Case rate,370.5,370.5, 382.20 ,351
32010003,EAP,CPT® 70030,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Eye For Foreign Body,1,198, 188.10 ,194.04, 188.10 , 192.06 , 188.10 ,Current Medicare Rates,192.06,190.08,Included in per diem,188.1,Included in ER Case rate,188.1,188.1, 194.04 ,178.2
32010011,EAP,CPT® 70140,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Facial Bones 1-2 Views,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32010012,EAP,CPT® 70150,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Facial Bones 3+ Views,1,500, 475.00 ,490, 475.00 , 485.00 , 475.00 ,Current Medicare Rates,485,480,Included in per diem,475,Included in ER Case rate,475,475, 490.00 ,450
32010614,EAP,CPT® 73551,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Femur 1 View,1,270, 256.50 ,264.6, 256.50 , 261.90 , 256.50 ,Current Medicare Rates,261.9,259.2,Included in per diem,256.5,Included in ER Case rate,256.5,256.5, 264.60 ,243
32010615,EAP,CPT® 73552,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Femur 2/> Views,1,345, 327.75 ,338.1, 327.75 , 334.65 , 327.75 ,Current Medicare Rates,334.65,331.2,Included in per diem,327.75,Included in ER Case rate,327.75,327.75, 338.10 ,310.5
32010131,EAP,CPT® 73140,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Fingers(s) 2 Views,1,256, 243.20 ,250.88, 243.20 , 248.32 , 243.20 ,Current Medicare Rates,248.32,245.76,Included in per diem,243.2,Included in ER Case rate,243.2,243.2, 250.88 ,230.4
32010110,EAP,CPT® 73620,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Foot 2 Views,1,266, 252.70 ,260.68, 252.70 , 258.02 , 252.70 ,Current Medicare Rates,258.02,255.36,Included in per diem,252.7,Included in ER Case rate,252.7,252.7, 260.68 ,239.4
32010091,EAP,CPT® 73630,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Foot 3 Views,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32010112,EAP,CPT® 73090,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Forearm 2 Views,1,295, 280.25 ,289.1, 280.25 , 286.15 , 280.25 ,Current Medicare Rates,286.15,283.2,Included in per diem,280.25,Included in ER Case rate,280.25,280.25, 289.10 ,265.5
32010127,EAP,CPT® 73120,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Hand 2 Views,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
32010129,EAP,CPT® 73130,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Hand 3+ Views,1,350, 332.50 ,343, 332.50 , 339.50 , 332.50 ,Current Medicare Rates,339.5,336,Included in per diem,332.5,Included in ER Case rate,332.5,332.5, 343.00 ,315
32010088,EAP,CPT® 73650,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Heel 2 Views,1,256, 243.20 ,250.88, 243.20 , 248.32 , 243.20 ,Current Medicare Rates,248.32,245.76,Included in per diem,243.2,Included in ER Case rate,243.2,243.2, 250.88 ,230.4
32010609,EAP,CPT® 73502,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC XR HIP UNILATERAL W/WO PELVIS 2-3 VIEWS,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010610,EAP,CPT® 73503,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Hip Unilateral W/wo Pelvis Minimum 4 Views,1,597, 567.15 ,585.06, 567.15 , 579.09 , 567.15 ,Current Medicare Rates,579.09,573.12,Included in per diem,567.15,Included in ER Case rate,567.15,567.15, 585.06 ,537.3
32010611,EAP,CPT® 73521,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Hips Bil 2 Views,1,475, 451.25 ,465.5, 451.25 , 460.75 , 451.25 ,Current Medicare Rates,460.75,456,Included in per diem,451.25,Included in ER Case rate,451.25,451.25, 465.50 ,427.5
32010612,EAP,CPT® 73522,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Hips Bil 3-4 Views,1,580, 551.00 ,568.4, 551.00 , 562.60 , 551.00 ,Current Medicare Rates,562.6,556.8,Included in per diem,551,Included in ER Case rate,551,551, 568.40 ,522
32010613,EAP,CPT® 73523,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Hips Bil 5/> Views,1,600, 570.00 ,588, 570.00 , 582.00 , 570.00 ,Current Medicare Rates,582,576,Included in per diem,570,Included in ER Case rate,570,570, 588.00 ,540
32010102,EAP,CPT® 73060,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Humerus 2+ Views,1,315, 299.25 ,308.7, 299.25 , 305.55 , 299.25 ,Current Medicare Rates,305.55,302.4,Included in per diem,299.25,Included in ER Case rate,299.25,299.25, 308.70 ,283.5
32010006,EAP,CPT® 70100,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Jaw 1-3 Views,1,253, 240.35 ,247.94, 240.35 , 245.41 , 240.35 ,Current Medicare Rates,245.41,242.88,Included in per diem,240.35,Included in ER Case rate,240.35,240.35, 247.94 ,227.7
32010007,EAP,CPT® 70110,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Jaw 4+ Views,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010027,EAP,CPT® 70328,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Jaw Joint,1,209, 198.55 ,204.82, 198.55 , 202.73 , 198.55 ,Current Medicare Rates,202.73,200.64,Included in per diem,198.55,Included in ER Case rate,198.55,198.55, 204.82 ,188.1
32010343,EAP,CPT® 77077,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Joint Survey 1 View,1,403, 382.85 ,394.94, 382.85 , 390.91 , 382.85 ,Current Medicare Rates,390.91,386.88,Included in per diem,382.85,Included in ER Case rate,382.85,382.85, 394.94 ,362.7
32010149,EAP,CPT® 73560,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Knee 1-2 Views,1,345, 327.75 ,338.1, 327.75 , 334.65 , 327.75 ,Current Medicare Rates,334.65,331.2,Included in per diem,327.75,Included in ER Case rate,327.75,327.75, 338.10 ,310.5
32010152,EAP,CPT® 73562,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Knee 3 Views,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010154,EAP,CPT® 73564,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Knee 4+ Views,1,560, 532.00 ,548.8, 532.00 , 543.20 , 532.00 ,Current Medicare Rates,543.2,537.6,Included in per diem,532,Included in ER Case rate,532,532, 548.80 ,504
32010156,EAP,CPT® 73565,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Knees Standing Bilat,1,344, 326.80 ,337.12, 326.80 , 333.68 , 326.80 ,Current Medicare Rates,333.68,330.24,Included in per diem,326.8,Included in ER Case rate,326.8,326.8, 337.12 ,309.6
32010161,EAP,CPT® 73592,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Leg Infant,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
32010159,EAP,CPT® 73590,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Lower Leg,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
32010014,EAP,CPT® 70160,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Nasal Bones 3+ Views,1,325, 308.75 ,318.5, 308.75 , 315.25 , 308.75 ,Current Medicare Rates,315.25,312,Included in per diem,308.75,Included in ER Case rate,308.75,308.75, 318.50 ,292.5
32010031,EAP,CPT® 70360,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Neck Soft Tissue,1,275, 261.25 ,269.5, 261.25 , 266.75 , 261.25 ,Current Medicare Rates,266.75,264,Included in per diem,261.25,Included in ER Case rate,261.25,261.25, 269.50 ,247.5
32010335,EAP,CPT® 77053,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC XR OF MAMMARY DUCT SINGLE,1,657, 624.15 ,643.86, 624.15 , 637.29 , 624.15 ,Current Medicare Rates,637.29,630.72,Included in per diem,624.15,Included in ER Case rate,624.15,624.15, 643.86 ,591.3
32010336,EAP,CPT® 77054,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC XR OF MAMMARY DUCTS MULTIPLE,1,859, 816.05 ,841.82, 816.05 , 833.23 , 816.05 ,Current Medicare Rates,833.23,824.64,Included in per diem,816.05,Included in ER Case rate,816.05,816.05, 841.82 ,773.1
32010016,EAP,CPT® 70190,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Optic Foramina,1,233, 221.35 ,228.34, 221.35 , 226.01 , 221.35 ,Current Medicare Rates,226.01,223.68,Included in per diem,221.35,Included in ER Case rate,221.35,221.35, 228.34 ,209.7
32010069,EAP,CPT® 72170,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Pelvis 1-2 Views,1,305, 289.75 ,298.9, 289.75 , 295.85 , 289.75 ,Current Medicare Rates,295.85,292.8,Included in per diem,289.75,Included in ER Case rate,289.75,289.75, 298.90 ,274.5
32010072,EAP,CPT® 72190,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Pelvis 3+ Views,1,360, 342.00 ,352.8, 342.00 , 349.20 , 342.00 ,Current Medicare Rates,349.2,345.6,Included in per diem,342,Included in ER Case rate,342,342, 352.80 ,324
32010045,EAP,CPT® 71100,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Ribs 2 Views,1,330, 313.50 ,323.4, 313.50 , 320.10 , 313.50 ,Current Medicare Rates,320.1,316.8,Included in per diem,313.5,Included in ER Case rate,313.5,313.5, 323.40 ,297
32010046,EAP,CPT® 71101,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Ribs/chest,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
32010049,EAP,CPT® 71111,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Ribs/chest Bilat,1,600, 570.00 ,588, 570.00 , 582.00 , 570.00 ,Current Medicare Rates,582,576,Included in per diem,570,Included in ER Case rate,570,570, 588.00 ,540
32010073,EAP,CPT® 72200,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Sacroiliac Joints 1-2 Views,1,320, 304.00 ,313.6, 304.00 , 310.40 , 304.00 ,Current Medicare Rates,310.4,307.2,Included in per diem,304,Included in ER Case rate,304,304, 313.60 ,288
32010074,EAP,CPT® 72202,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Sacroiliac Joints 3+ Views,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010089,EAP,CPT® 73010,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Scapula,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32010021,EAP,CPT® 70240,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Sella Turcica,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
32010092,EAP,CPT® 73020,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Shoulder 1 View,1,242, 229.90 ,237.16, 229.90 , 234.74 , 229.90 ,Current Medicare Rates,234.74,232.32,Included in per diem,229.9,Included in ER Case rate,229.9,229.9, 237.16 ,217.8
32010481,EAP,CPT® 73030,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Shoulder 2+ Views Complete,1,375, 356.25 ,367.5, 356.25 , 363.75 , 356.25 ,Current Medicare Rates,363.75,360,Included in per diem,356.25,Included in ER Case rate,356.25,356.25, 367.50 ,337.5
32010099,EAP,CPT® 73050,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,HC XR SHOULDER ACROMIO-CLAVICULAR JOINTS,1,380, 361.00 ,372.4, 361.00 , 368.60 , 361.00 ,Current Medicare Rates,368.6,364.8,Included in per diem,361,Included in ER Case rate,361,361, 372.40 ,342
32010018,EAP,CPT® 70210,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Sinuses 1-2 Views,1,233, 221.35 ,228.34, 221.35 , 226.01 , 221.35 ,Current Medicare Rates,226.01,223.68,Included in per diem,221.35,Included in ER Case rate,221.35,221.35, 228.34 ,209.7
32010020,EAP,CPT® 70220,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Sinuses 3+ Views,1,500, 475.00 ,490, 475.00 , 485.00 , 475.00 ,Current Medicare Rates,485,480,Included in per diem,475,Included in ER Case rate,475,475, 490.00 ,450
32010022,EAP,CPT® 70250,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Skull 1-3 Views,1,352, 334.40 ,344.96, 334.40 , 341.44 , 334.40 ,Current Medicare Rates,341.44,337.92,Included in per diem,334.4,Included in ER Case rate,334.4,334.4, 344.96 ,316.8
32010023,EAP,CPT® 70260,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Skull 4+ Views,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010187,EAP,CPT® 74250,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Small Bowel,1,460, 437.00 ,450.8, 437.00 , 446.20 , 437.00 ,Current Medicare Rates,446.2,441.6,Included in per diem,437,Included in ER Case rate,437,437, 450.80 ,414
32010053,EAP,CPT® 72020,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine 1 View Any Level,1,230, 218.50 ,225.4, 218.50 , 223.10 , 218.50 ,Current Medicare Rates,223.1,220.8,Included in per diem,218.5,Included in ER Case rate,218.5,218.5, 225.40 ,207
32010059,EAP,CPT® 72070,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine 2 Views Thoracic,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010062,EAP,CPT® 72080,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine 2 Views Thoraco-lumbar,1,350, 332.50 ,343, 332.50 , 339.50 , 332.50 ,Current Medicare Rates,339.5,336,Included in per diem,332.5,Included in ER Case rate,332.5,332.5, 343.00 ,315
32010065,EAP,CPT® 72100,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine 2-3 Views Lumbar,1,356, 338.20 ,348.88, 338.20 , 345.32 , 338.20 ,Current Medicare Rates,345.32,341.76,Included in per diem,338.2,Included in ER Case rate,338.2,338.2, 348.88 ,320.4
32010068,EAP,CPT® 72120,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine 2-3 Views Lumbar Bend Only,1,637, 605.15 ,624.26, 605.15 , 617.89 , 605.15 ,Current Medicare Rates,617.89,611.52,Included in per diem,605.15,Included in ER Case rate,605.15,605.15, 624.26 ,573.3
32010060,EAP,CPT® 72072,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine 3 Views Thoracic,1,440, 418.00 ,431.2, 418.00 , 426.80 , 418.00 ,Current Medicare Rates,426.8,422.4,Included in per diem,418,Included in ER Case rate,418,418, 431.20 ,396
32010066,EAP,CPT® 72110,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine 4+ Views Lumbar,1,575, 546.25 ,563.5, 546.25 , 557.75 , 546.25 ,Current Medicare Rates,557.75,552,Included in per diem,546.25,Included in ER Case rate,546.25,546.25, 563.50 ,517.5
32010067,EAP,CPT® 72114,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Spine Lumbar Incl Bending,1,400.00, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
32010051,EAP,CPT® 71130,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Sterno-clavicular Joints,1,276, 262.20 ,270.48, 262.20 , 267.72 , 262.20 ,Current Medicare Rates,267.72,264.96,Included in per diem,262.2,Included in ER Case rate,262.2,262.2, 270.48 ,248.4
32010050,EAP,CPT® 71120,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Sternum,1,325, 308.75 ,318.5, 308.75 , 315.25 , 308.75 ,Current Medicare Rates,315.25,312,Included in per diem,308.75,Included in ER Case rate,308.75,308.75, 318.50 ,292.5
32010322,EAP,CPT® 76098,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Surgical Specimen,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
32010075,EAP,CPT® 72220,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Tailbone 2+ Views,1,300, 285.00 ,294, 285.00 , 291.00 , 285.00 ,Current Medicare Rates,291,288,Included in per diem,285,Included in ER Case rate,285,285, 294.00 ,270
32010004,EAP,CPT® 73660,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Toes(s) 2 Views,1,230, 218.50 ,225.4, 218.50 , 223.10 , 218.50 ,Current Medicare Rates,223.1,220.8,Included in per diem,218.5,Included in ER Case rate,218.5,218.5, 225.40 ,207
32010217,EAP,CPT® 74455,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Urethrocystogram Voiding,1,461, 437.95 ,451.78, 437.95 , 447.17 , 437.95 ,Current Medicare Rates,447.17,442.56,Included in per diem,437.95,Included in ER Case rate,437.95,437.95, 451.78 ,414.9
32010117,EAP,CPT® 73100,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Wrist 1 View,1,255, 242.25 ,249.9, 242.25 , 247.35 , 242.25 ,Current Medicare Rates,247.35,244.8,Included in per diem,242.25,Included in ER Case rate,242.25,242.25, 249.90 ,229.5
32010118,EAP,CPT® 73100,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Wrist 2 Views,1,255, 242.25 ,249.9, 242.25 , 247.35 , 242.25 ,Current Medicare Rates,247.35,244.8,Included in per diem,242.25,Included in ER Case rate,242.25,242.25, 249.90 ,229.5
32010119,EAP,CPT® 73110,,0320 - RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION,Hc Xr Wrist 3+ Views,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
32410018,EAP,CPT® 71045,,0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY,Hc Xr Chest Portable 1 View,1,310, 294.50 ,303.8, 294.50 , 300.70 , 294.50 ,Current Medicare Rates,300.7,297.6,Included in per diem,294.5,Included in ER Case rate,294.5,294.5, 303.80 ,279
32410014,EAP,CPT® 71045,,0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY,Hc Xr Exam Chest 1 View,1,310, 294.50 ,303.8, 294.50 , 300.70 , 294.50 ,Current Medicare Rates,300.7,297.6,Included in per diem,294.5,Included in ER Case rate,294.5,294.5, 303.80 ,279
32410015,EAP,CPT® 71046,,0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY,Hc Xr Exam Chest 2 Views,1,360, 342.00 ,352.8, 342.00 , 349.20 , 342.00 ,Current Medicare Rates,349.2,345.6,Included in per diem,342,Included in ER Case rate,342,342, 352.80 ,324
32410016,EAP,CPT® 71047,,0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY,Hc Xr Exam Chest 3 Views,1,360, 342.00 ,352.8, 342.00 , 349.20 , 342.00 ,Current Medicare Rates,349.2,345.6,Included in per diem,342,Included in ER Case rate,342,342, 352.80 ,324
32410017,EAP,CPT® 71048,,0324 - RADIOLOGY - DIAGNOSTIC - CHEST X-RAY,Hc Xr Exam Chest 4+ Views,1,368, 349.60 ,360.64, 349.60 , 356.96 , 349.60 ,Current Medicare Rates,356.96,353.28,Included in per diem,349.6,Included in ER Case rate,349.6,349.6, 360.64 ,331.2
33110001,EAP,CPT® 96401,,0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED,Hc Chemo Anti-neopl Sq/im^,1,219, 208.05 ,214.62, 208.05 , 212.43 , 208.05 ,Current Medicare Rates,212.43,210.24,Included in per diem,208.05,Included in ER Case rate,208.05,208.05, 214.62 ,197.1
33110002,EAP,CPT® 96402,,0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED,Hc Chemo Hormon Antineopl Sq/im^,1,228, 216.60 ,223.44, 216.60 , 221.16 , 216.60 ,Current Medicare Rates,221.16,218.88,Included in per diem,216.6,Included in ER Case rate,216.6,216.6, 223.44 ,205.2
33110007,EAP,CPT® 96409,,0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED,Hc Chemo Iv Push Sngl Drug^,1,275, 261.25 ,269.5, 261.25 , 266.75 , 261.25 ,Current Medicare Rates,266.75,264,Included in per diem,261.25,Included in ER Case rate,261.25,261.25, 269.50 ,247.5
33110006,EAP,CPT® 96542,,0331 - RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED,Hc Chemotherapy Injection Via Subq Reservoir^,1,540, 513.00 ,529.2, 513.00 , 523.80 , 513.00 ,Current Medicare Rates,523.8,518.4,Included in per diem,513,Included in ER Case rate,513,513, 529.20 ,486
33510006,EAP,CPT® 96417,,0335 - CHEMOTHERAPY - IV ADMINISTRATION,Hc Chemo Iv Infus Each Addl Seq^,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
33510003,EAP,CPT® 96413,,0335 - CHEMOTHERAPY - IV ADMINISTRATION,Hc Chemo Iv Infusion 1 Hr^,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
33510004,EAP,CPT® 96415,,0335 - CHEMOTHERAPY - IV ADMINISTRATION,Hc Chemo Iv Infusion Addl Hr^,1,165, 156.75 ,161.7, 156.75 , 160.05 , 156.75 ,Current Medicare Rates,160.05,158.4,Included in per diem,156.75,Included in ER Case rate,156.75,156.75, 161.70 ,148.5
33510002,EAP,CPT® 96411,,0335 - CHEMOTHERAPY - IV ADMINISTRATION,Hc Chemo Iv Push Addl Drug^,1,240, 228.00 ,235.2, 228.00 , 232.80 , 228.00 ,Current Medicare Rates,232.8,230.4,Included in per diem,228,Included in ER Case rate,228,228, 235.20 ,216
33510005,EAP,CPT® 96416,,0335 - CHEMOTHERAPY - IV ADMINISTRATION,Hc Chemo Prolong Infuse W/implanted Pump^,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
33510018,EAP,CPT® 96415,,0335 - CHEMOTHERAPY - IV ADMINISTRATION,Hc Tysabri Infusion Each Add'l Hr,1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
33510017,EAP,CPT® 96413,,0335 - CHEMOTHERAPY - IV ADMINISTRATION,Hc Tysabri Infusion First Hr,1,586, 556.70 ,574.28, 556.70 , 568.42 , 556.70 ,Current Medicare Rates,568.42,562.56,Included in per diem,556.7,Included in ER Case rate,556.7,556.7, 574.28 ,527.4
35010032,EAP,CPT® 76376,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc 3d Render W/o Postprocess,1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
35010033,EAP,CPT® 76377,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc 3d Rendering W/postprocess,1,814, 773.30 ,797.72, 773.30 , 789.58 , 773.30 ,Current Medicare Rates,789.58,781.44,Included in per diem,773.3,Included in ER Case rate,773.3,773.3, 797.72 ,732.6
35010024,EAP,CPT® 74176,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Abd & Pelvis W/o Contrast,1,3400," 3,230.00 ",3332," 3,230.00 "," 3,298.00 "," 3,230.00 ",Current Medicare Rates,3298,3264,Included in per diem,3230,Included in ER Case rate,3230,3230," 3,332.00 ",3060
35010025,EAP,CPT® 74177,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Abdomen & Pelvis W/ Dye,1,4000," 3,800.00 ",3920," 3,800.00 "," 3,880.00 "," 3,800.00 ",Current Medicare Rates,3880,3840,Included in per diem,3800,Included in ER Case rate,3800,3800," 3,920.00 ",3600
35010072,EAP,CPT® 74174,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Angio Abdomen Pelvis,1,3800," 3,610.00 ",3724," 3,610.00 "," 3,686.00 "," 3,610.00 ",Current Medicare Rates,3686,3648,Included in per diem,3610,Included in ER Case rate,3610,3610," 3,724.00 ",3420
35010023,EAP,CPT® 74175,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Angio Abdomen W/o & W/dye,1,2775," 2,636.25 ",2719.5," 2,636.25 "," 2,691.75 "," 2,636.25 ",Current Medicare Rates,2691.75,2664,Included in per diem,2636.25,Included in ER Case rate,2636.25,2636.25," 2,719.50 ",2497.5
35010031,EAP,CPT® 75635,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Angio Abdominal Arteries,1,2600," 2,470.00 ",2548," 2,470.00 "," 2,522.00 "," 2,470.00 ",Current Medicare Rates,2522,2496,Included in per diem,2470,Included in ER Case rate,2470,2470," 2,548.00 ",2340
35010020,EAP,CPT® 73706,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Angio Lwr Extr W/o&w/dye,1,2575," 2,446.25 ",2523.5," 2,446.25 "," 2,497.75 "," 2,446.25 ",Current Medicare Rates,2497.75,2472,Included in per diem,2446.25,Included in ER Case rate,2446.25,2446.25," 2,523.50 ",2317.5
35010013,EAP,CPT® 71275,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Angiography Chest,1,2500," 2,375.00 ",2450," 2,375.00 "," 2,425.00 "," 2,375.00 ",Current Medicare Rates,2425,2400,Included in per diem,2375,Included in ER Case rate,2375,2375," 2,450.00 ",2250
35010010,EAP,CPT® 70498,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Angiography Neck W/ And W/o Dye,1,2350," 2,232.50 ",2303," 2,232.50 "," 2,279.50 "," 2,232.50 ",Current Medicare Rates,2279.5,2256,Included in per diem,2232.5,Included in ER Case rate,2232.5,2232.5," 2,303.00 ",2115
35210030,EAP,CPT® 73700,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Lower Extremity W/o Dye,1,1700," 1,615.00 ",1666," 1,615.00 "," 1,649.00 "," 1,615.00 ",Current Medicare Rates,1649,1632,Included in per diem,1615,Included in ER Case rate,1615,1615," 1,666.00 ",1530
35010018,EAP,CPT® 73702,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Lwr Extremity W/o&w/dye,1,2038," 1,936.10 ",1997.24," 1,936.10 "," 1,976.86 "," 1,936.10 ",Current Medicare Rates,1976.86,1956.48,Included in per diem,1936.1,Included in ER Case rate,1936.1,1936.1," 1,997.24 ",1834.2
35110022,EAP,CPT® 70486,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Maxillofacial W/o Dye,1,1325," 1,258.75 ",1298.5," 1,258.75 "," 1,285.25 "," 1,258.75 ",Current Medicare Rates,1285.25,1272,Included in per diem,1258.75,Included in ER Case rate,1258.75,1258.75," 1,298.50 ",1192.5
35010006,EAP,CPT® 70488,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Maxillofacial/sinus W/o & W/dye,1,2128," 2,021.60 ",2085.44," 2,021.60 "," 2,064.16 "," 2,021.60 ",Current Medicare Rates,2064.16,2042.88,Included in per diem,2021.6,Included in ER Case rate,2021.6,2021.6," 2,085.44 ",1915.2
35010037,EAP,CPT® 77012,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Scan For Needle Bx/asp/inj,1,1800," 1,710.00 ",1764," 1,710.00 "," 1,746.00 "," 1,710.00 ",Current Medicare Rates,1746,1728,Included in per diem,1710,Included in ER Case rate,1710,1710," 1,764.00 ",1620
35010009,EAP,CPT® 70492,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Sft Tsue Nck W/o & W/dye,1,2309," 2,193.55 ",2262.82," 2,193.55 "," 2,239.73 "," 2,193.55 ",Current Medicare Rates,2239.73,2216.64,Included in per diem,2193.55,Included in ER Case rate,2193.55,2193.55," 2,262.82 ",2078.1
35010008,EAP,CPT® 70491,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Soft Tissue Neck W/dye,1,1900," 1,805.00 ",1862," 1,805.00 "," 1,843.00 "," 1,805.00 ",Current Medicare Rates,1843,1824,Included in per diem,1805,Included in ER Case rate,1805,1805," 1,862.00 ",1710
35010007,EAP,CPT® 70490,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Soft Tissue Neck W/o Dye,1,1592," 1,512.40 ",1560.16," 1,512.40 "," 1,544.24 "," 1,512.40 ",Current Medicare Rates,1544.24,1528.32,Included in per diem,1512.4,Included in ER Case rate,1512.4,1512.4," 1,560.16 ",1432.8
35010011,EAP,CPT® 71250,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Thorax W/o Dye,1,1800," 1,710.00 ",1764," 1,710.00 "," 1,746.00 "," 1,710.00 ",Current Medicare Rates,1746,1728,Included in per diem,1710,Included in ER Case rate,1710,1710," 1,764.00 ",1620
35210029,EAP,CPT® 73200,,0350 - CT SCAN - GENERAL CLASSIFICATION,Hc Ct Upper Extremity W/o Dye,1,1610," 1,529.50 ",1577.8," 1,529.50 "," 1,561.70 "," 1,529.50 ",Current Medicare Rates,1561.7,1545.6,Included in per diem,1529.5,Included in ER Case rate,1529.5,1529.5," 1,577.80 ",1449
35110032,EAP,CPT® 70496,,0351 - CT SCAN - HEAD SCAN,Hc Ct Angiography Head,1,2350," 2,232.50 ",2303," 2,232.50 "," 2,279.50 "," 2,232.50 ",Current Medicare Rates,2279.5,2256,Included in per diem,2232.5,Included in ER Case rate,2232.5,2232.5," 2,303.00 ",2115
35110007,EAP,CPT® 70460,,0351 - CT SCAN - HEAD SCAN,Hc Ct Head/brain W/dye,1,1745," 1,657.75 ",1710.1," 1,657.75 "," 1,692.65 "," 1,657.75 ",Current Medicare Rates,1692.65,1675.2,Included in per diem,1657.75,Included in ER Case rate,1657.75,1657.75," 1,710.10 ",1570.5
35110012,EAP,CPT® 70470,,0351 - CT SCAN - HEAD SCAN,Hc Ct Head/brain W/o & W/dye,1,2333," 2,216.35 ",2286.34," 2,216.35 "," 2,263.01 "," 2,216.35 ",Current Medicare Rates,2263.01,2239.68,Included in per diem,2216.35,Included in ER Case rate,2216.35,2216.35," 2,286.34 ",2099.7
35110002,EAP,CPT® 70450,,0351 - CT SCAN - HEAD SCAN,Hc Ct Head/brain W/o Dye,1,1750," 1,662.50 ",1715," 1,662.50 "," 1,697.50 "," 1,662.50 ",Current Medicare Rates,1697.5,1680,Included in per diem,1662.5,Included in ER Case rate,1662.5,1662.5," 1,715.00 ",1575
35110030,EAP,CPT® 70487,,0351 - CT SCAN - HEAD SCAN,Hc Ct Maxillofacial W/dye,1,1750," 1,662.50 ",1715," 1,662.50 "," 1,697.50 "," 1,662.50 ",Current Medicare Rates,1697.5,1680,Included in per diem,1662.5,Included in ER Case rate,1662.5,1662.5," 1,715.00 ",1575
35110017,EAP,CPT® 70481,,0351 - CT SCAN - HEAD SCAN,Hc Ct Orbit/ear/fossa W/dye,1,1675," 1,591.25 ",1641.5," 1,591.25 "," 1,624.75 "," 1,591.25 ",Current Medicare Rates,1624.75,1608,Included in per diem,1591.25,Included in ER Case rate,1591.25,1591.25," 1,641.50 ",1507.5
35110014,EAP,CPT® 70480,,0351 - CT SCAN - HEAD SCAN,Hc Ct Orbit/ear/fossa W/o Dye,1,1572," 1,493.40 ",1540.56," 1,493.40 "," 1,524.84 "," 1,493.40 ",Current Medicare Rates,1524.84,1509.12,Included in per diem,1493.4,Included in ER Case rate,1493.4,1493.4," 1,540.56 ",1414.8
35110019,EAP,CPT® 70482,,0351 - CT SCAN - HEAD SCAN,Hc Ct Orbit/ear/fossa W/o&w/dye,1,2043," 1,940.85 ",2002.14," 1,940.85 "," 1,981.71 "," 1,940.85 ",Current Medicare Rates,1981.71,1961.28,Included in per diem,1940.85,Included in ER Case rate,1940.85,1940.85," 2,002.14 ",1838.7
35210054,EAP,CPT® 74178,,0352 - CT SCAN - BODY SCAN,Hc Ct Abdomen & Pelvis W/wo Dye,1,4200," 3,990.00 ",4116," 3,990.00 "," 4,074.00 "," 3,990.00 ",Current Medicare Rates,4074,4032,Included in per diem,3990,Included in ER Case rate,3990,3990," 4,116.00 ",3780
35210046,EAP,CPT® 74160,,0352 - CT SCAN - BODY SCAN,Hc Ct Abdomen W/dye,1,2200," 2,090.00 ",2156," 2,090.00 "," 2,134.00 "," 2,090.00 ",Current Medicare Rates,2134,2112,Included in per diem,2090,Included in ER Case rate,2090,2090," 2,156.00 ",1980
35210047,EAP,CPT® 74170,,0352 - CT SCAN - BODY SCAN,Hc Ct Abdomen W/o & W/dye,1,2400," 2,280.00 ",2352," 2,280.00 "," 2,328.00 "," 2,280.00 ",Current Medicare Rates,2328,2304,Included in per diem,2280,Included in ER Case rate,2280,2280," 2,352.00 ",2160
35210038,EAP,CPT® 74150,,0352 - CT SCAN - BODY SCAN,Hc Ct Abdomen W/o Dye,1,1850," 1,757.50 ",1813," 1,757.50 "," 1,794.50 "," 1,757.50 ",Current Medicare Rates,1794.5,1776,Included in per diem,1757.5,Included in ER Case rate,1757.5,1757.5," 1,813.00 ",1665
35210017,EAP,CPT® 72191,,0352 - CT SCAN - BODY SCAN,Hc Ct Angiograph Pelv W/o&w/dye,1,2210," 2,099.50 ",2165.8," 2,099.50 "," 2,143.70 "," 2,099.50 ",Current Medicare Rates,2143.7,2121.6,Included in per diem,2099.5,Included in ER Case rate,2099.5,2099.5," 2,165.80 ",1989
35210012,EAP,CPT® 72129,,0352 - CT SCAN - BODY SCAN,Hc Ct Chest Spine W/dye,1,2000," 1,900.00 ",1960," 1,900.00 "," 1,940.00 "," 1,900.00 ",Current Medicare Rates,1940,1920,Included in per diem,1900,Included in ER Case rate,1900,1900," 1,960.00 ",1800
35210013,EAP,CPT® 72130,,0352 - CT SCAN - BODY SCAN,Hc Ct Chest Spine W/o & W/dye,1,2521," 2,394.95 ",2470.58," 2,394.95 "," 2,445.37 "," 2,394.95 ",Current Medicare Rates,2445.37,2420.16,Included in per diem,2394.95,Included in ER Case rate,2394.95,2394.95," 2,470.58 ",2268.9
35210011,EAP,CPT® 72128,,0352 - CT SCAN - BODY SCAN,Hc Ct Chest Spine W/o Dye,1,1830," 1,738.50 ",1793.4," 1,738.50 "," 1,775.10 "," 1,738.50 ",Current Medicare Rates,1775.1,1756.8,Included in per diem,1738.5,Included in ER Case rate,1738.5,1738.5," 1,793.40 ",1647
35210040,EAP,CPT® 73701,,0352 - CT SCAN - BODY SCAN,Hc Ct Lower Extremity W/dye,1,2000," 1,900.00 ",1960," 1,900.00 "," 1,940.00 "," 1,900.00 ",Current Medicare Rates,1940,1920,Included in per diem,1900,Included in ER Case rate,1900,1900," 1,960.00 ",1800
35210015,EAP,CPT® 72132,,0352 - CT SCAN - BODY SCAN,Hc Ct Lumbar Spine W/dye,1,2060," 1,957.00 ",2018.8," 1,957.00 "," 1,998.20 "," 1,957.00 ",Current Medicare Rates,1998.2,1977.6,Included in per diem,1957,Included in ER Case rate,1957,1957," 2,018.80 ",1854
35210016,EAP,CPT® 72133,,0352 - CT SCAN - BODY SCAN,Hc Ct Lumbar Spine W/o & W/dye,1,2478," 2,354.10 ",2428.44," 2,354.10 "," 2,403.66 "," 2,354.10 ",Current Medicare Rates,2403.66,2378.88,Included in per diem,2354.1,Included in ER Case rate,2354.1,2354.1," 2,428.44 ",2230.2
35210014,EAP,CPT® 72131,,0352 - CT SCAN - BODY SCAN,Hc Ct Lumbar Spine W/o Dye,1,1700," 1,615.00 ",1666," 1,615.00 "," 1,649.00 "," 1,615.00 ",Current Medicare Rates,1649,1632,Included in per diem,1615,Included in ER Case rate,1615,1615," 1,666.00 ",1530
35210009,EAP,CPT® 72126,,0352 - CT SCAN - BODY SCAN,Hc Ct Neck Spine W/dye,1,2164," 2,055.80 ",2120.72," 2,055.80 "," 2,099.08 "," 2,055.80 ",Current Medicare Rates,2099.08,2077.44,Included in per diem,2055.8,Included in ER Case rate,2055.8,2055.8," 2,120.72 ",1947.6
35210010,EAP,CPT® 72127,,0352 - CT SCAN - BODY SCAN,Hc Ct Neck Spine W/o & W/dye,1,2263," 2,149.85 ",2217.74," 2,149.85 "," 2,195.11 "," 2,149.85 ",Current Medicare Rates,2195.11,2172.48,Included in per diem,2149.85,Included in ER Case rate,2149.85,2149.85," 2,217.74 ",2036.7
35210008,EAP,CPT® 72125,,0352 - CT SCAN - BODY SCAN,Hc Ct Neck Spine W/o Dye,1,1825," 1,733.75 ",1788.5," 1,733.75 "," 1,770.25 "," 1,733.75 ",Current Medicare Rates,1770.25,1752,Included in per diem,1733.75,Included in ER Case rate,1733.75,1733.75," 1,788.50 ",1642.5
35210020,EAP,CPT® 72193,,0352 - CT SCAN - BODY SCAN,Hc Ct Pelvis W/dye,1,2036," 1,934.20 ",1995.28," 1,934.20 "," 1,974.92 "," 1,934.20 ",Current Medicare Rates,1974.92,1954.56,Included in per diem,1934.2,Included in ER Case rate,1934.2,1934.2," 1,995.28 ",1832.4
35210024,EAP,CPT® 72194,,0352 - CT SCAN - BODY SCAN,Hc Ct Pelvis W/o & W/dye,1,2407," 2,286.65 ",2358.86," 2,286.65 "," 2,334.79 "," 2,286.65 ",Current Medicare Rates,2334.79,2310.72,Included in per diem,2286.65,Included in ER Case rate,2286.65,2286.65," 2,358.86 ",2166.3
35210018,EAP,CPT® 72192,,0352 - CT SCAN - BODY SCAN,Hc Ct Pelvis W/o Dye,1,1760," 1,672.00 ",1724.8," 1,672.00 "," 1,707.20 "," 1,672.00 ",Current Medicare Rates,1707.2,1689.6,Included in per diem,1672,Included in ER Case rate,1672,1672," 1,724.80 ",1584
35200001,EAP,71271,,0352 - CT SCAN - BODY SCAN,HC CT THORAX LW DOSE LNG CA SCR WO CONTRAST CDM,1,1853," 1,760.35 ",1815.94," 1,760.35 "," 1,797.41 "," 1,760.35 ",Current Medicare Rates,1797.41,1778.88,Included in per diem,1760.35,Included in ER Case rate,1760.35,1760.35," 1,815.94 ",1667.7
35210003,EAP,CPT® 71260,,0352 - CT SCAN - BODY SCAN,Hc Ct Thorax W/dye,1,2225," 2,113.75 ",2180.5," 2,113.75 "," 2,158.25 "," 2,113.75 ",Current Medicare Rates,2158.25,2136,Included in per diem,2113.75,Included in ER Case rate,2113.75,2113.75," 2,180.50 ",2002.5
35210006,EAP,CPT® 71270,,0352 - CT SCAN - BODY SCAN,Hc Ct Thorax W/o & W/dye,1,2778," 2,639.10 ",2722.44," 2,639.10 "," 2,694.66 "," 2,639.10 ",Current Medicare Rates,2694.66,2666.88,Included in per diem,2639.1,Included in ER Case rate,2639.1,2639.1," 2,722.44 ",2500.2
35210105,EAP,CPT® 71250,,0352 - CT SCAN - BODY SCAN,Hc Ct Thorax W/o Dye F/u Lung Screening,1,"1,834.00"," 1,742.30 ",1797.32," 1,742.30 "," 1,778.98 "," 1,742.30 ",Current Medicare Rates,1778.98,1760.64,Included in per diem,1742.3,Included in ER Case rate,1742.3,1742.3," 1,797.32 ",1650.6
35210031,EAP,CPT® 73201,,0352 - CT SCAN - BODY SCAN,Hc Ct Upper Extremity W/dye,1,1800," 1,710.00 ",1764," 1,710.00 "," 1,746.00 "," 1,710.00 ",Current Medicare Rates,1746,1728,Included in per diem,1710,Included in ER Case rate,1710,1710," 1,764.00 ",1620
36010172,EAP,CPT® 66984,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,HC CATARACT REMOVE W/IOL ETRACAPSULAR 66984,1,3818," 3,627.10 ",3741.64," 3,627.10 "," 3,703.46 "," 3,627.10 ",Current Medicare Rates,3703.46,3665.28,Included in per diem,3627.1,Included in ER Case rate,3627.1,3627.1," 3,741.64 ",3436.2
36011039,EAP,CPT® 21337,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Closed Treatment Nasal Septal Fracture,1,1235," 1,173.25 ",1210.3," 1,173.25 "," 1,197.95 "," 1,173.25 ",Current Medicare Rates,1197.95,1185.6,Included in per diem,1173.25,Included in ER Case rate,1173.25,1173.25," 1,210.30 ",1111.5
36010557,EAP,CPT® 21931,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Exc Back Les Sc 3 Cm/>,1,1133," 1,076.35 ",1110.34," 1,076.35 "," 1,099.01 "," 1,076.35 ",Current Medicare Rates,1099.01,1087.68,Included in per diem,1076.35,Included in ER Case rate,1076.35,1076.35," 1,110.34 ",1019.7
36010567,EAP,CPT® 25075,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Exc Forearm Les Sc < 3 Cm,1,1220," 1,159.00 ",1195.6," 1,159.00 "," 1,183.40 "," 1,159.00 ",Current Medicare Rates,1183.4,1171.2,Included in per diem,1159,Included in ER Case rate,1159,1159," 1,195.60 ",1098
36011109,EAP,CPT® 44970,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Laparoscopy Appendectomy,1,1685," 1,600.75 ",1651.3," 1,600.75 "," 1,634.45 "," 1,600.75 ",Current Medicare Rates,1634.45,1617.6,Included in per diem,1600.75,Included in ER Case rate,1600.75,1600.75," 1,651.30 ",1516.5
36010146,EAP,Custom 36010146,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 1 1st 30 Mins,1,1559," 1,481.05 ",1527.82," 1,481.05 "," 1,512.23 "," 1,481.05 ",Current Medicare Rates,1512.23,1496.64,Included in per diem,1481.05,Included in ER Case rate,1481.05,1481.05," 1,527.82 ",1403.1
36010211,EAP,Custom 36010211,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 1 Add'l 15 Min,1,701, 665.95 ,686.98, 665.95 , 679.97 , 665.95 ,Current Medicare Rates,679.97,672.96,Included in per diem,665.95,Included in ER Case rate,665.95,665.95, 686.98 ,630.9
36010147,EAP,Custom 36010147,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 2 1st 30 Mins,1,2500," 2,375.00 ",2450," 2,375.00 "," 2,425.00 "," 2,375.00 ",Current Medicare Rates,2425,2400,Included in per diem,2375,Included in ER Case rate,2375,2375," 2,450.00 ",2250
36010213,EAP,Custom 36010213,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 2 Add'l 15 Min,1,950, 902.50 ,931, 902.50 , 921.50 , 902.50 ,Current Medicare Rates,921.5,912,Included in per diem,902.5,Included in ER Case rate,902.5,902.5, 931.00 ,855
36010148,EAP,Custom 36010148,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 3 1st 30 Mins,1,"3,150.00"," 2,992.50 ",3087," 2,992.50 "," 3,055.50 "," 2,992.50 ",Current Medicare Rates,3055.5,3024,Included in per diem,2992.5,Included in ER Case rate,2992.5,2992.5," 3,087.00 ",2835
36010215,EAP,Custom 36010215,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 3 Add'l 15 Min,1,1050, 997.50 ,1029, 997.50 ," 1,018.50 ", 997.50 ,Current Medicare Rates,1018.5,1008,Included in per diem,997.5,Included in ER Case rate,997.5,997.5," 1,029.00 ",945
36010149,EAP,Custom 36010149,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 4 1st 30 Mins,1,3750," 3,562.50 ",3675," 3,562.50 "," 3,637.50 "," 3,562.50 ",Current Medicare Rates,3637.5,3600,Included in per diem,3562.5,Included in ER Case rate,3562.5,3562.5," 3,675.00 ",3375
36010217,EAP,Custom 36010217,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 4 Add'l 15 Min,1,1150," 1,092.50 ",1127," 1,092.50 "," 1,115.50 "," 1,092.50 ",Current Medicare Rates,1115.5,1104,Included in per diem,1092.5,Included in ER Case rate,1092.5,1092.5," 1,127.00 ",1035
36010150,EAP,Custom 36010150,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 5 1st 30 Mins,1,4350," 4,132.50 ",4263," 4,132.50 "," 4,219.50 "," 4,132.50 ",Current Medicare Rates,4219.5,4176,Included in per diem,4132.5,Included in ER Case rate,4132.5,4132.5," 4,263.00 ",3915
36010219,EAP,Custom 36010219,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 5 Add'l 15 Min,1,1250," 1,187.50 ",1225," 1,187.50 "," 1,212.50 "," 1,187.50 ",Current Medicare Rates,1212.5,1200,Included in per diem,1187.5,Included in ER Case rate,1187.5,1187.5," 1,225.00 ",1125
36010151,EAP,Custom 36010151,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 6 1st 30 Mins,1,4950," 4,702.50 ",4851," 4,702.50 "," 4,801.50 "," 4,702.50 ",Current Medicare Rates,4801.5,4752,Included in per diem,4702.5,Included in ER Case rate,4702.5,4702.5," 4,851.00 ",4455
36010221,EAP,Custom 36010221,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Operating Room Services Level 6 Add'l 15 Min,1,1350," 1,282.50 ",1323," 1,282.50 "," 1,309.50 "," 1,282.50 ",Current Medicare Rates,1309.5,1296,Included in per diem,1282.5,Included in ER Case rate,1282.5,1282.5," 1,323.00 ",1215
36011144,EAP,CPT® 56700,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Partial Removal Of Hymen,1,1179," 1,120.05 ",1155.42," 1,120.05 "," 1,143.63 "," 1,120.05 ",Current Medicare Rates,1143.63,1131.84,Included in per diem,1120.05,Included in ER Case rate,1120.05,1120.05," 1,155.42 ",1061.1
36011154,EAP,CPT® 26548,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Reconstruct Finger Joint,1,2893," 2,748.35 ",2835.14," 2,748.35 "," 2,806.21 "," 2,748.35 ",Current Medicare Rates,2806.21,2777.28,Included in per diem,2748.35,Included in ER Case rate,2748.35,2748.35," 2,835.14 ",2603.7
36011159,EAP,CPT® 46230,,0360 - OPERATING ROOM SERVICES - GENERAL CLASSIFICATION,Hc Removal Of Anal Tags,1,805, 764.75 ,788.9, 764.75 , 780.85 , 764.75 ,Current Medicare Rates,780.85,772.8,Included in per diem,764.75,Included in ER Case rate,764.75,764.75, 788.90 ,724.5
36110662,EAP,CPT® 49083,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Abdom Paracentesis Dx/ther W/imaging Guidance^,1,1025, 973.75 ,1004.5, 973.75 , 994.25 , 973.75 ,Current Medicare Rates,994.25,984,Included in per diem,973.75,Included in ER Case rate,973.75,973.75," 1,004.50 ",922.5
36111099,EAP,CPT® 66821,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc After Cataract Laser Surgery,1,1899," 1,804.05 ",1861.02," 1,804.05 "," 1,842.03 "," 1,804.05 ",Current Medicare Rates,1842.03,1823.04,Included in per diem,1804.05,Included in ER Case rate,1804.05,1804.05," 1,861.02 ",1709.1
36110558,EAP,CPT® 20220,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Bone Biopsy Trocar/needle Superficial,1,1368," 1,299.60 ",1340.64," 1,299.60 "," 1,326.96 "," 1,299.60 ",Current Medicare Rates,1326.96,1313.28,Included in per diem,1299.6,Included in ER Case rate,1299.6,1299.6," 1,340.64 ",1231.2
36111185,EAP,CPT® 19083,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Bx Breast 1st Lesion Us Imag,1,826, 784.70 ,809.48, 784.70 , 801.22 , 784.70 ,Current Medicare Rates,801.22,792.96,Included in per diem,784.7,Included in ER Case rate,784.7,784.7, 809.48 ,743.4
36111186,EAP,CPT® 19084,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Bx Breast Add Lesion Us Imag,1,831, 789.45 ,814.38, 789.45 , 806.07 , 789.45 ,Current Medicare Rates,806.07,797.76,Included in per diem,789.45,Included in ER Case rate,789.45,789.45, 814.38 ,747.9
36110687,EAP,CPT® 51705,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC CYSTOSTOMY TUBE CHANGE,1,330, 313.50 ,323.4, 313.50 , 320.10 , 313.50 ,Current Medicare Rates,320.1,316.8,Included in per diem,313.5,Included in ER Case rate,313.5,313.5, 323.40 ,297
36110005,EAP,CPT® 36593,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Declot Vascular Device,1,93, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,Included in per diem,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
36010122,EAP,CPT® 20205,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Deep Muscle Biopsy,1,3320," 3,154.00 ",3253.6," 3,154.00 "," 3,220.40 "," 3,154.00 ",Current Medicare Rates,3220.4,3187.2,Included in per diem,3154,Included in ER Case rate,3154,3154," 3,253.60 ",2988
36010406,EAP,CPT® 38221,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC DIAGNOSTIC  BONE MARROW BIOPSIES,1,652, 619.40 ,638.96, 619.40 , 632.44 , 619.40 ,Current Medicare Rates,632.44,625.92,Included in per diem,619.4,Included in ER Case rate,619.4,619.4, 638.96 ,586.8
36110101,EAP,CPT® 38220,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC DIAGNOSTIC BONE MARROW ASPIRATIONS,1,625, 593.75 ,612.5, 593.75 , 606.25 , 593.75 ,Current Medicare Rates,606.25,600,Included in per diem,593.75,Included in ER Case rate,593.75,593.75, 612.50 ,562.5
36010131,EAP,CPT® 20605,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC DRAIN/INJECT JOINT/BURSA INTERM  W/O ULTRASOUND GUIDANCE,1,222, 210.90 ,217.56, 210.90 , 215.34 , 210.90 ,Current Medicare Rates,215.34,213.12,Included in per diem,210.9,Included in ER Case rate,210.9,210.9, 217.56 ,199.8
36110562,EAP,CPT® 20610,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC DRAIN/INJECT JOINT/BURSA MAJOR JOINT W/O ULTRASOUND GUIDANCE,1,309, 293.55 ,302.82, 293.55 , 299.73 , 293.55 ,Current Medicare Rates,299.73,296.64,Included in per diem,293.55,Included in ER Case rate,293.55,293.55, 302.82 ,278.1
36010130,EAP,CPT® 20600,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Drain/inject Joint/bursa Small W/o Ultrasound Guidance,1,217, 206.15 ,212.66, 206.15 , 210.49 , 206.15 ,Current Medicare Rates,210.49,208.32,Included in per diem,206.15,Included in ER Case rate,206.15,206.15, 212.66 ,195.3
36010111,EAP,CPT® 19000,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC DRAINAGE OF BREAST LESION,1,436, 414.20 ,427.28, 414.20 , 422.92 , 414.20 ,Current Medicare Rates,422.92,418.56,Included in per diem,414.2,Included in ER Case rate,414.2,414.2, 427.28 ,392.4
36110239,EAP,CPT® 10005,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Fine Needle Aspiration Bx W/us Gdn 1st Lesion,1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,Included in per diem,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
36111182,EAP,CPT® 10030,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Guide Cath Fluid Drainage Soft Tissue,1,831, 789.45 ,814.38, 789.45 , 806.07 , 789.45 ,Current Medicare Rates,806.07,797.76,Included in per diem,789.45,Included in ER Case rate,789.45,789.45, 814.38 ,747.9
36114046,EAP,CPT® 62320,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Inj Interlaminar Crv/thrc W/o Img,1,1150," 1,092.50 ",1127," 1,092.50 "," 1,115.50 "," 1,092.50 ",Current Medicare Rates,1115.5,1104,Included in per diem,1092.5,Included in ER Case rate,1092.5,1092.5," 1,127.00 ",1035
36114054,EAP,CPT® 62322,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Inj Interlaminar Lmbr/sac W/o Img,1,1150," 1,092.50 ",1127," 1,092.50 "," 1,115.50 "," 1,092.50 ",Current Medicare Rates,1115.5,1104,Included in per diem,1092.5,Included in ER Case rate,1092.5,1092.5," 1,127.00 ",1035
36114051,EAP,CPT® 62326,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Inj Interlaminar Lmbr/sac W/o Img,1,1150," 1,092.50 ",1127," 1,092.50 "," 1,115.50 "," 1,092.50 ",Current Medicare Rates,1115.5,1104,Included in per diem,1092.5,Included in ER Case rate,1092.5,1092.5," 1,127.00 ",1035
36114049,EAP,CPT® 62324,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Inj Intralaminar Crv/thrc W/o Img,1,1150," 1,092.50 ",1127," 1,092.50 "," 1,115.50 "," 1,092.50 ",Current Medicare Rates,1115.5,1104,Included in per diem,1092.5,Included in ER Case rate,1092.5,1092.5," 1,127.00 ",1035
36110072,EAP,CPT® 62273,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Inject Epidural Patch,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
36110100,EAP,Custom 11981,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Insert Drug Implant Device,1,336, 319.20 ,329.28, 319.20 , 325.92 , 319.20 ,Current Medicare Rates,325.92,322.56,Included in per diem,319.2,Included in ER Case rate,319.2,319.2, 329.28 ,302.4
36110619,EAP,CPT® 31500,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Insert Emergency Airway,1,686, 651.70 ,672.28, 651.70 , 665.42 , 651.70 ,Current Medicare Rates,665.42,658.56,Included in per diem,651.7,Included in ER Case rate,651.7,651.7, 672.28 ,617.4
36110418,EAP,CPT® 36556,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Insert Non-tunnel Cv Cath > 5,1,683, 648.85 ,669.34, 648.85 , 662.51 , 648.85 ,Current Medicare Rates,662.51,655.68,Included in per diem,648.85,Included in ER Case rate,648.85,648.85, 669.34 ,614.7
36110622,EAP,CPT® 32551,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Insertion Of Chest Tube,1,1404," 1,333.80 ",1375.92," 1,333.80 "," 1,361.88 "," 1,333.80 ",Current Medicare Rates,1361.88,1347.84,Included in per diem,1333.8,Included in ER Case rate,1333.8,1333.8," 1,375.92 ",1263.6
36110432,EAP,CPT® 36569,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC INSERTION PICC W/O IMG GDN 5 YR/>,1,2753," 2,615.35 ",2697.94," 2,615.35 "," 2,670.41 "," 2,615.35 ",Current Medicare Rates,2670.41,2642.88,Included in per diem,2615.35,Included in ER Case rate,2615.35,2615.35," 2,697.94 ",2477.7
36110646,EAP,51798,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM,1,58, 55.10 ,56.84, 55.10 , 56.26 , 55.10 ,Current Medicare Rates,56.26,55.68,Included in per diem,55.1,Included in ER Case rate,55.1,55.1, 56.84 ,52.2
36110646,EAP,51798,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM,1,58, 55.10 ,56.84, 55.10 , 56.26 , 55.10 ,Current Medicare Rates,56.26,55.68,Included in per diem,55.1,Included in ER Case rate,55.1,55.1, 56.84 ,52.2
36110646,EAP,51798,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,HC MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM,1,58, 55.10 ,56.84, 55.10 , 56.26 , 55.10 ,Current Medicare Rates,56.26,55.68,Included in per diem,55.1,Included in ER Case rate,55.1,55.1, 56.84 ,52.2
36111193,EAP,CPT® 19285,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Perq Dev Loc Breast 1st Us Imag,1,311.00, 295.45 ,304.78, 295.45 , 301.67 , 295.45 ,Current Medicare Rates,301.67,298.56,Included in per diem,295.45,Included in ER Case rate,295.45,295.45, 304.78 ,279.9
36111189,EAP,CPT® 19281,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Perq Device Loc Breast 1st Imag,1,389, 369.55 ,381.22, 369.55 , 377.33 , 369.55 ,Current Medicare Rates,377.33,373.44,Included in per diem,369.55,Included in ER Case rate,369.55,369.55, 381.22 ,350.1
36111127,EAP,CPT® 32557,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Perq Drainage Pleura Insert Cath W/imaging,1,523, 496.85 ,512.54, 496.85 , 507.31 , 496.85 ,Current Medicare Rates,507.31,502.08,Included in per diem,496.85,Included in ER Case rate,496.85,496.85, 512.54 ,470.7
36010110,EAP,CPT® 10160,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Puncture Drainage/aspiration Of Lesion,1,264, 250.80 ,258.72, 250.80 , 256.08 , 250.80 ,Current Medicare Rates,256.08,253.44,Included in per diem,250.8,Included in ER Case rate,250.8,250.8, 258.72 ,237.6
36112019,EAP,CPT® 20665,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Removal Of Tongs Or Halo,1,585, 555.75 ,573.3, 555.75 , 567.45 , 555.75 ,Current Medicare Rates,567.45,561.6,Included in per diem,555.75,Included in ER Case rate,555.75,555.75, 573.30 ,526.5
36110071,EAP,CPT® 62270,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Spinal Fluid Tap Diagnostic,1,537, 510.15 ,526.26, 510.15 , 520.89 , 510.15 ,Current Medicare Rates,520.89,515.52,Included in per diem,510.15,Included in ER Case rate,510.15,510.15, 526.26 ,483.3
36111125,EAP,CPT® 32555,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Thoracentesis Needle/cath Pleura W/imaging,1,976, 927.20 ,956.48, 927.20 , 946.72 , 927.20 ,Current Medicare Rates,946.72,936.96,Included in per diem,927.2,Included in ER Case rate,927.2,927.2, 956.48 ,878.4
36111124,EAP,CPT® 32554,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Thoracentesis Needle/cath Pleura W/o Imaging,1,558, 530.10 ,546.84, 530.10 , 541.26 , 530.10 ,Current Medicare Rates,541.26,535.68,Included in per diem,530.1,Included in ER Case rate,530.1,530.1, 546.84 ,502.2
36110912,EAP,CPT® 32560,,0361 - OPERATING ROOM SERVICES - MINOR SURGERY,Hc Treat Pleurodesis W/agent,1,855, 812.25 ,837.9, 812.25 , 829.35 , 812.25 ,Current Medicare Rates,829.35,820.8,Included in per diem,812.25,Included in ER Case rate,812.25,812.25, 837.90 ,769.5
37010156,EAP,99157,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS,1,232, 220.40 ,227.36, 220.40 , 225.04 , 220.40 ,Current Medicare Rates,225.04,222.72,Included in per diem,220.4,Included in ER Case rate,220.4,220.4, 227.36 ,208.8
37010154,EAP,99155,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS<5YRS,1,424, 402.80 ,415.52, 402.80 , 411.28 , 402.80 ,Current Medicare Rates,411.28,407.04,Included in per diem,402.8,Included in ER Case rate,402.8,402.8, 415.52 ,381.6
37010155,EAP,99156,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,HC MOD SED OTHER PHYS/QHP INITIAL 15MINS >5YRS,1,424.00, 402.80 ,415.52, 402.80 , 411.28 , 402.80 ,Current Medicare Rates,411.28,407.04,Included in per diem,402.8,Included in ER Case rate,402.8,402.8, 415.52 ,381.6
37010153,EAP,99153,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS,1,230, 218.50 ,225.4, 218.50 , 223.10 , 218.50 ,Current Medicare Rates,223.1,220.8,Included in per diem,218.5,Included in ER Case rate,218.5,218.5, 225.40 ,207
37010151,EAP,99151,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,HC MOD SED SAME PHYS/QHP INITIAL 15 MINS<5YRS,1,424, 402.80 ,415.52, 402.80 , 411.28 , 402.80 ,Current Medicare Rates,411.28,407.04,Included in per diem,402.8,Included in ER Case rate,402.8,402.8, 415.52 ,381.6
37010152,EAP,99152,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,HC MOD SED SAME PHYS/QHP INITIAL 15 MINS>5YRS,1,423, 401.85 ,414.54, 401.85 , 410.31 , 401.85 ,Current Medicare Rates,410.31,406.08,Included in per diem,401.85,Included in ER Case rate,401.85,401.85, 414.54 ,380.7
37010116,EAP,Custom 37010116,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,Hc Anesthesia Gen By Min Cdm,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,Included in per diem,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
37010118,EAP,Custom 37010118,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,Hc Anesthesia Mac By Min Cdm,1,17, 16.15 ,16.66, 16.15 , 16.49 , 16.15 ,Current Medicare Rates,16.49,16.32,Included in per diem,16.15,Included in ER Case rate,16.15,16.15, 16.66 ,15.3
37010120,EAP,Custom 37010120,,0370 - ANESTHESIA - GENERAL CLASSIFICATION,Hc Anesthesia Regional By Min Cdm,1,17, 16.15 ,16.66, 16.15 , 16.49 , 16.15 ,Current Medicare Rates,16.49,16.32,Included in per diem,16.15,Included in ER Case rate,16.15,16.15, 16.66 ,15.3
39010045,EAP,HCPCS P9059,,"0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION",Hc Fresh Frozen Plasma Frz Between 8-24hour,1,156, 148.20 ,152.88, 148.20 , 151.32 , 148.20 ,Current Medicare Rates,151.32,149.76,Included in per diem,148.2,Included in ER Case rate,148.2,148.2, 152.88 ,140.4
39010031,EAP,HCPCS P9035,,"0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION",Hc Platelet Pheresis Leukoreduced,1,1434," 1,362.30 ",1405.32," 1,362.30 "," 1,390.98 "," 1,362.30 ",Current Medicare Rates,1390.98,1376.64,Included in per diem,1362.3,Included in ER Case rate,1362.3,1362.3," 1,405.32 ",1290.6
39010042,EAP,HCPCS P9055,,"0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION",Hc Plt Pheresis Lr Cmv Neg,1,926, 879.70 ,907.48, 879.70 , 898.22 , 879.70 ,Current Medicare Rates,898.22,888.96,Included in per diem,879.7,Included in ER Case rate,879.7,879.7, 907.48 ,833.4
30011053,EAP,CPT® 86870,,"0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION",Hc Rbc Antibody Identification - Panel,1,213, 202.35 ,208.74, 202.35 , 206.61 , 202.35 ,Current Medicare Rates,206.61,204.48,Included in per diem,202.35,Included in ER Case rate,202.35,202.35, 208.74 ,191.7
39010044,EAP,HCPCS P9058,,"0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION",Hc Rbc Leukored Irrad Cmv Neg Ea,1,112, 106.40 ,109.76, 106.40 , 108.64 , 106.40 ,Current Medicare Rates,108.64,107.52,Included in per diem,106.4,Included in ER Case rate,106.4,106.4, 109.76 ,100.8
39010015,EAP,HCPCS P9016,,"0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION",Hc Rbc Leukoreduced,1,426, 404.70 ,417.48, 404.70 , 413.22 , 404.70 ,Current Medicare Rates,413.22,408.96,Included in per diem,404.7,Included in ER Case rate,404.7,404.7, 417.48 ,383.4
39010055,EAP,HCPCS P9040,,"0390 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION",Hc Rbc Leukoreduced Irradiated,1,492, 467.40 ,482.16, 467.40 , 477.24 , 467.40 ,Current Medicare Rates,477.24,472.32,Included in per diem,467.4,Included in ER Case rate,467.4,467.4, 482.16 ,442.8
39110001,EAP,CPT® 36430,,"0391 - ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - ADMINISTRATION (E.G., TRANS",Hc Blood Transfusion Service 1 Unit Cdm,1,305, 289.75 ,298.9, 289.75 , 295.85 , 289.75 ,Current Medicare Rates,295.85,292.8,Included in per diem,289.75,Included in ER Case rate,289.75,289.75, 298.90 ,274.5
40110024,EAP,CPT® 77066,,0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY,Hc Dx Mammo Incl Cad Bi,1,437, 415.15 ,428.26, 415.15 , 423.89 , 415.15 ,Current Medicare Rates,423.89,419.52,Included in per diem,415.15,Included in ER Case rate,415.15,415.15, 428.26 ,393.3
40110023,EAP,CPT® 77065,,0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY,Hc Dx Mammo Incl Cad Uni,1,366, 347.70 ,358.68, 347.70 , 355.02 , 347.70 ,Current Medicare Rates,355.02,351.36,Included in per diem,347.7,Included in ER Case rate,347.7,347.7, 358.68 ,329.4
40110004,EAP,CPT® 77066,,0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY,HC MAMMO DIAG DIGITAL BILAT,1,475, 451.25 ,465.5, 451.25 , 460.75 , 451.25 ,Current Medicare Rates,460.75,456,Included in per diem,451.25,Included in ER Case rate,451.25,451.25, 465.50 ,427.5
40110005,EAP,CPT® 77065,,0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY,HC MAMMO DIAG DIGITAL UNILAT,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
40110021,EAP,HCPCS G0279,,0401 - OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY,HC TOMOSYNTHESIS MAMMO UNI or BIL DIAGNOSTIC    ,1,116, 110.20 ,113.68, 110.20 , 112.52 , 110.20 ,Current Medicare Rates,112.52,111.36,Included in per diem,110.2,Included in ER Case rate,110.2,110.2, 113.68 ,104.4
40210001,EAP,CPT® 76506,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Echo Exam Of Head,1,747, 709.65 ,732.06, 709.65 , 724.59 , 709.65 ,Current Medicare Rates,724.59,717.12,Included in per diem,709.65,Included in ER Case rate,709.65,709.65, 732.06 ,672.3
40210061,EAP,CPT® 76999,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Echo Examination Procedure Unlisted,1,0, -   ,0, -   , -   , -   ,Current Medicare Rates,0,0,Included in per diem,0,Included in ER Case rate,0,0, -   ,0
40210053,EAP,CPT® 76946,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Echo Guide For Amniocentesis,1,540, 513.00 ,529.2, 513.00 , 523.80 , 513.00 ,Current Medicare Rates,523.8,518.4,Included in per diem,513,Included in ER Case rate,513,513, 529.20 ,486
40210052,EAP,CPT® 76942,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,HC ECHO GUIDE FOR BIOPSY,1,550, 522.50 ,539, 522.50 , 533.50 , 522.50 ,Current Medicare Rates,533.5,528,Included in per diem,522.5,Included in ER Case rate,522.5,522.5, 539.00 ,495
40210142,EAP,CPT® 76706,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Abd Aorta Scrn Aaa,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
40210008,EAP,CPT® 76700,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Abdomen Complete,1,800, 760.00 ,784, 760.00 , 776.00 , 760.00 ,Current Medicare Rates,776,768,Included in per diem,760,Included in ER Case rate,760,760, 784.00 ,720
40210005,EAP,CPT® 76604,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Chest,1,550, 522.50 ,539, 522.50 , 533.50 , 522.50 ,Current Medicare Rates,533.5,528,Included in per diem,522.5,Included in ER Case rate,522.5,522.5, 539.00 ,495
40210012,EAP,CPT® 76776,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Kidney Transplant W/doppler,1,445, 422.75 ,436.1, 422.75 , 431.65 , 422.75 ,Current Medicare Rates,431.65,427.2,Included in per diem,422.75,Included in ER Case rate,422.75,422.75, 436.10 ,400.5
40210104,EAP,CPT® 76705,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Of Abdomen Limited,1,523, 496.85 ,512.54, 496.85 , 507.31 , 496.85 ,Current Medicare Rates,507.31,502.08,Included in per diem,496.85,Included in ER Case rate,496.85,496.85, 512.54 ,470.7
40210004,EAP,CPT® 76536,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Of Head And Neck,1,556, 528.20 ,544.88, 528.20 , 539.32 , 528.20 ,Current Medicare Rates,539.32,533.76,Included in per diem,528.2,Included in ER Case rate,528.2,528.2, 544.88 ,500.4
40210093,EAP,CPT® 76856,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Pelvic Complete,1,725, 688.75 ,710.5, 688.75 , 703.25 , 688.75 ,Current Medicare Rates,703.25,696,Included in per diem,688.75,Included in ER Case rate,688.75,688.75, 710.50 ,652.5
40210035,EAP,CPT® 76857,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Pelvic Follicle Limited,1,460, 437.00 ,450.8, 437.00 , 446.20 , 437.00 ,Current Medicare Rates,446.2,441.6,Included in per diem,437,Included in ER Case rate,437,437, 450.80 ,414
40210009,EAP,CPT® 76857,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Pelvic Limited,1,460, 437.00 ,450.8, 437.00 , 446.20 , 437.00 ,Current Medicare Rates,446.2,441.6,Included in per diem,437,Included in ER Case rate,437,437, 450.80 ,414
40210036,EAP,CPT® 76870,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Scrotum & Contents,1,700, 665.00 ,686, 665.00 , 679.00 , 665.00 ,Current Medicare Rates,679,672,Included in per diem,665,Included in ER Case rate,665,665, 686.00 ,630
40210013,EAP,CPT® 76800,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Exam Spinal Canal & Contents,1,575, 546.25 ,563.5, 546.25 , 557.75 , 546.25 ,Current Medicare Rates,557.75,552,Included in per diem,546.25,Included in ER Case rate,546.25,546.25, 563.50 ,517.5
40210112,EAP,CPT® 76882,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ext Non-vasc Axilla Limited,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
40210041,EAP,CPT® 76881,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ext Non-vasc Complete,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
40210043,EAP,CPT® 76882,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ext Non-vasc Limited,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
40210025,EAP,CPT® 76818,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Fetal Biophys Profile W/nst,1,475, 451.25 ,465.5, 451.25 , 460.75 , 451.25 ,Current Medicare Rates,460.75,456,Included in per diem,451.25,Included in ER Case rate,451.25,451.25, 465.50 ,427.5
40210026,EAP,CPT® 76819,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Fetal Biophys Profile W/o Nst,1,635, 603.25 ,622.3, 603.25 , 615.95 , 603.25 ,Current Medicare Rates,615.95,609.6,Included in per diem,603.25,Included in ER Case rate,603.25,603.25, 622.30 ,571.5
40210059,EAP,CPT® 76998,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Guide Intraop,1,695, 660.25 ,681.1, 660.25 , 674.15 , 660.25 ,Current Medicare Rates,674.15,667.2,Included in per diem,660.25,Included in ER Case rate,660.25,660.25, 681.10 ,625.5
40210049,EAP,CPT® 76937,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Guide Vascular Access,1,350, 332.50 ,343, 332.50 , 339.50 , 332.50 ,Current Medicare Rates,339.5,336,Included in per diem,332.5,Included in ER Case rate,332.5,332.5, 343.00 ,315
40210028,EAP,CPT® 76821,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Middle Cerebral Artery Echo,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
40210015,EAP,CPT® 76802,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob < 14 Wks Addl Fetus,1,568, 539.60 ,556.64, 539.60 , 550.96 , 539.60 ,Current Medicare Rates,550.96,545.28,Included in per diem,539.6,Included in ER Case rate,539.6,539.6, 556.64 ,511.2
40210014,EAP,CPT® 76801,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob < 14 Wks Single Fetus,1,635, 603.25 ,622.3, 603.25 , 615.95 , 603.25 ,Current Medicare Rates,615.95,609.6,Included in per diem,603.25,Included in ER Case rate,603.25,603.25, 622.30 ,571.5
40210016,EAP,CPT® 76805,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob >= 14 Wks Single Fetus,1,565, 536.75 ,553.7, 536.75 , 548.05 , 536.75 ,Current Medicare Rates,548.05,542.4,Included in per diem,536.75,Included in ER Case rate,536.75,536.75, 553.70 ,508.5
40210019,EAP,CPT® 76812,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob Detailed Addl Fetus,1,562, 533.90 ,550.76, 533.90 , 545.14 , 533.90 ,Current Medicare Rates,545.14,539.52,Included in per diem,533.9,Included in ER Case rate,533.9,533.9, 550.76 ,505.8
40210018,EAP,CPT® 76811,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob Detailed Single Fetus,1,800, 760.00 ,784, 760.00 , 776.00 , 760.00 ,Current Medicare Rates,776,768,Included in per diem,760,Included in ER Case rate,760,760, 784.00 ,720
40210023,EAP,CPT® 76816,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob Follow-up Per Fetus,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
40210022,EAP,CPT® 76815,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob Limited Fetus(s),1,510, 484.50 ,499.8, 484.50 , 494.70 , 484.50 ,Current Medicare Rates,494.7,489.6,Included in per diem,484.5,Included in ER Case rate,484.5,484.5, 499.80 ,459
40210020,EAP,CPT® 76813,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob Nuchal Measurement 1 Gest,1,492, 467.40 ,482.16, 467.40 , 477.24 , 467.40 ,Current Medicare Rates,477.24,472.32,Included in per diem,467.4,Included in ER Case rate,467.4,467.4, 482.16 ,442.8
40210021,EAP,CPT® 76814,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob Nuchal Measurement Add Gest,1,562, 533.90 ,550.76, 533.90 , 545.14 , 533.90 ,Current Medicare Rates,545.14,539.52,Included in per diem,533.9,Included in ER Case rate,533.9,533.9, 550.76 ,505.8
40210024,EAP,CPT® 76817,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob Transvaginal,1,325, 308.75 ,318.5, 308.75 , 315.25 , 308.75 ,Current Medicare Rates,315.25,312,Included in per diem,308.75,Included in ER Case rate,308.75,308.75, 318.50 ,292.5
40210017,EAP,CPT® 76810,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Ob>= 14 Wks Addl Fetus,1,487, 462.65 ,477.26, 462.65 , 472.39 , 462.65 ,Current Medicare Rates,472.39,467.52,Included in per diem,462.65,Included in ER Case rate,462.65,462.65, 477.26 ,438.3
40210010,EAP,CPT® 76770,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Retroperitoneal Complete,1,725, 688.75 ,710.5, 688.75 , 703.25 , 688.75 ,Current Medicare Rates,703.25,696,Included in per diem,688.75,Included in ER Case rate,688.75,688.75, 710.50 ,652.5
40210011,EAP,CPT® 76775,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Retroperitoneal Limited,1,510, 484.50 ,499.8, 484.50 , 494.70 , 484.50 ,Current Medicare Rates,494.7,489.6,Included in per diem,484.5,Included in ER Case rate,484.5,484.5, 499.80 ,459
40210033,EAP,CPT® 76830,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Transvaginal Non-ob,1,745, 707.75 ,730.1, 707.75 , 722.65 , 707.75 ,Current Medicare Rates,722.65,715.2,Included in per diem,707.75,Included in ER Case rate,707.75,707.75, 730.10 ,670.5
40210076,EAP,CPT® 76820,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Umbilical Artery Echo,1,466, 442.70 ,456.68, 442.70 , 452.02 , 442.70 ,Current Medicare Rates,452.02,447.36,Included in per diem,442.7,Included in ER Case rate,442.7,442.7, 456.68 ,419.4
40210136,EAP,CPT® 76641,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Uni Breast Complete,1,556, 528.20 ,544.88, 528.20 , 539.32 , 528.20 ,Current Medicare Rates,539.32,533.76,Included in per diem,528.2,Included in ER Case rate,528.2,528.2, 544.88 ,500.4
40210137,EAP,CPT® 76642,,0402 - OTHER IMAGING SERVICES - ULTRASOUND,Hc Us Uni Breast Limited,1,556, 528.20 ,544.88, 528.20 , 539.32 , 528.20 ,Current Medicare Rates,539.32,533.76,Included in per diem,528.2,Included in ER Case rate,528.2,528.2, 544.88 ,500.4
40310004,EAP,CPT® 77067,,0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY,HC MAMMO SCREEN DIGITAL BILAT,1,385, 365.75 ,377.3, 365.75 , 373.45 , 365.75 ,Current Medicare Rates,373.45,369.6,Included in per diem,365.75,Included in ER Case rate,365.75,365.75, 377.30 ,346.5
40310005,EAP,CPT® 77067,,0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY,HC MAMMO SCREEN DIGITAL UNILAT INC CAD,1,350, 332.50 ,343, 332.50 , 339.50 , 332.50 ,Current Medicare Rates,339.5,336,Included in per diem,332.5,Included in ER Case rate,332.5,332.5, 343.00 ,315
40310012,EAP,CPT® 77067,,0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY,Hc Screen Mammo Bi Incl Cad,1,339, 322.05 ,332.22, 322.05 , 328.83 , 322.05 ,Current Medicare Rates,328.83,325.44,Included in per diem,322.05,Included in ER Case rate,322.05,322.05, 332.22 ,305.1
40110020,EAP,CPT® 77063,,0403 - OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY,Hc Screening Breast Tomosynthesis Bi,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
41010006,EAP,CPT® 36600,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Blood Sampling Percutaneous Puncture,1,129, 122.55 ,126.42, 122.55 , 125.13 , 122.55 ,Current Medicare Rates,125.13,123.84,Included in per diem,122.55,Included in ER Case rate,122.55,122.55, 126.42 ,116.1
41010007,EAP,CPT® 92950,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,HC CARDIOPULMONARY RESUSCITATION,1,750, 712.50 ,735, 712.50 , 727.50 , 712.50 ,Current Medicare Rates,727.5,720,Included in per diem,712.5,Included in ER Case rate,712.5,712.5, 735.00 ,675
41010261,EAP,CPT® 94667,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Expiratory Pressure Valve Therapy Initial,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,Included in per diem,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
41010263,EAP,CPT® 94668,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Expiratory Pressure Valve Therapy Subsequent,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,Included in per diem,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
41010275,EAP,CPT® 94640,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,HC High Flow Therapy Daily,1,103, 97.85 ,100.94, 97.85 , 99.91 , 97.85 ,Current Medicare Rates,99.91,98.88,Included in per diem,97.85,Included in ER Case rate,97.85,97.85, 100.94 ,92.7
41010366,EAP,CPT® 94660,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Home Cpap Management Daily,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
41010023,EAP,CPT® 94669,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Mechanical Chest Wall Oscill,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
41010290,EAP,CPT® 94002,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Mechanical Ventilation First Day,1,1450," 1,377.50 ",1421," 1,377.50 "," 1,406.50 "," 1,377.50 ",Current Medicare Rates,1406.5,1392,Included in per diem,1377.5,Included in ER Case rate,1377.5,1377.5," 1,421.00 ",1305
41010296,EAP,CPT® 94003,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Mechanical Ventilation Subsequent Day,1,710, 674.50 ,695.8, 674.50 , 688.70 , 674.50 ,Current Medicare Rates,688.7,681.6,Included in per diem,674.5,Included in ER Case rate,674.5,674.5, 695.80 ,639
36010965,EAP,CPT® 99465,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Newborn Resuscitation,1,391, 371.45 ,383.18, 371.45 , 379.27 , 371.45 ,Current Medicare Rates,379.27,375.36,Included in per diem,371.45,Included in ER Case rate,371.45,371.45, 383.18 ,351.9
41010325,EAP,CPT® 94660,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Noninvasive Ventilation/cpap First Day,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
41010328,EAP,CPT® 94660,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Noninvasive Ventilation/cpap Subsequent Day,1,400, 380.00 ,392, 380.00 , 388.00 , 380.00 ,Current Medicare Rates,388,384,Included in per diem,380,Included in ER Case rate,380,380, 392.00 ,360
41010012,EAP,CPT® 94761,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Pulse Oximetry Multiple Determinations,1,116, 110.20 ,113.68, 110.20 , 112.52 , 110.20 ,Current Medicare Rates,112.52,111.36,Included in per diem,110.2,Included in ER Case rate,110.2,110.2, 113.68 ,104.4
41010013,EAP,CPT® 94762,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Pulse Oximetry Nocturnal Study,1,214, 203.30 ,209.72, 203.30 , 207.58 , 203.30 ,Current Medicare Rates,207.58,205.44,Included in per diem,203.3,Included in ER Case rate,203.3,203.3, 209.72 ,192.6
41010412,EAP,CPT® 94799,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Resp Consult,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
41010353,EAP,CPT® 94640,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Sputum Induction,1,116, 110.20 ,113.68, 110.20 , 112.52 , 110.20 ,Current Medicare Rates,112.52,111.36,Included in per diem,110.2,Included in ER Case rate,110.2,110.2, 113.68 ,104.4
41010406,EAP,CPT® 31502,,0410 - RESPIRATORY SERVICES - GENERAL CLASSIFICATION,Hc Tracheostomy Tube Change,1,270, 256.50 ,264.6, 256.50 , 261.90 , 256.50 ,Current Medicare Rates,261.9,259.2,Included in per diem,256.5,Included in ER Case rate,256.5,256.5, 264.60 ,243
41210009,EAP,CPT® 94664,,0412 - RESPIRATORY SERVICES - INHALATION SERVICES,"Hc Demo And/or Eval Of Patient Utilization Of A Nebulizer,inhaler,ippb Or Aerosol Device",1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
41210004,EAP,CPT® 94640,,0412 - RESPIRATORY SERVICES - INHALATION SERVICES,Hc Meter Dose Inhaler,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
41210044,EAP,CPT® 94645,,0412 - RESPIRATORY SERVICES - INHALATION SERVICES,Hc Nebulizer Continuous Ea Subsequent Hour,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
41210008,EAP,CPT® 94644,,0412 - RESPIRATORY SERVICES - INHALATION SERVICES,Hc Nebulizer Continuous First Hour,1,148, 140.60 ,145.04, 140.60 , 143.56 , 140.60 ,Current Medicare Rates,143.56,142.08,Included in per diem,140.6,Included in ER Case rate,140.6,140.6, 145.04 ,133.2
41010237,EAP,CPT® 94645,,0412 - RESPIRATORY SERVICES - INHALATION SERVICES,Hc Nebulizer Continuous Subsequent Hour,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
41210006,EAP,CPT® 94640,,0412 - RESPIRATORY SERVICES - INHALATION SERVICES,Hc Nebulizer Small Volume,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
42010153,EAP,97150,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,HC GROUP THERAPEUTIC PROCEDURES,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
42010080,EAP,CPT® 29580,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Application Of Unaboot,1,208, 197.60 ,203.84, 197.60 , 201.76 , 197.60 ,Current Medicare Rates,201.76,199.68,Included in per diem,197.6,Included in ER Case rate,197.6,197.6, 203.84 ,187.2
42010141,EAP,CPT® 97113,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Aquatic Therapy/exercises - 15 Min,1,142, 134.90 ,139.16, 134.90 , 137.74 , 134.90 ,Current Medicare Rates,137.74,136.32,Included in per diem,134.9,Included in ER Case rate,134.9,134.9, 139.16 ,127.8
42010270,EAP,HCPCS G0283,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Elec Stim Other Than Wound,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
42010113,EAP,CPT® 97014,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,HC ELECTRIC STIM THER,1,129, 122.55 ,126.42, 122.55 , 125.13 , 122.55 ,Current Medicare Rates,125.13,123.84,Included in per diem,122.55,Included in ER Case rate,122.55,122.55, 126.42 ,116.1
42010124,EAP,CPT® 97032,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Electrical Stimulation Attended, Ea 15 Min",1,123, 116.85 ,120.54, 116.85 , 119.31 , 116.85 ,Current Medicare Rates,119.31,118.08,Included in per diem,116.85,Included in ER Case rate,116.85,116.85, 120.54 ,110.7
42010142,EAP,CPT® 97116,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Gait Training Therapy, Ea 15 Min",1,103.00, 97.85 ,100.94, 97.85 , 99.91 , 97.85 ,Current Medicare Rates,99.91,98.88,Included in per diem,97.85,Included in ER Case rate,97.85,97.85, 100.94 ,92.7
42010125,EAP,CPT® 97033,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Iontophoresis Per 15-min,1,103, 97.85 ,100.94, 97.85 , 99.91 , 97.85 ,Current Medicare Rates,99.91,98.88,Included in per diem,97.85,Included in ER Case rate,97.85,97.85, 100.94 ,92.7
42010150,EAP,CPT® 97140,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Manual Therapy, Ea 15 Min",1,113, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
42010110,EAP,CPT® 97012,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Mechanical Traction Therapy,1,86.00, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
42010139,EAP,CPT® 97112,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Neuromuscular Reeducation, Ea 15 Min",1,113.00, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
42010264,EAP,CPT® 97760,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Orthotic Mgmt And Training, Ea 15 Min",1,116.00, 110.20 ,113.68, 110.20 , 112.52 , 110.20 ,Current Medicare Rates,112.52,111.36,Included in per diem,110.2,Included in ER Case rate,110.2,110.2, 113.68 ,104.4
42010248,EAP,CPT® 97750,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Physical Performance Test, Ea 15 Min",1,104.00, 98.80 ,101.92, 98.80 , 100.88 , 98.80 ,Current Medicare Rates,100.88,99.84,Included in per diem,98.8,Included in ER Case rate,98.8,98.8, 101.92 ,93.6
42010265,EAP,CPT® 97761,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Prosthetic Training, Ea 15 Min",1,108.00, 102.60 ,105.84, 102.60 , 104.76 , 102.60 ,Current Medicare Rates,104.76,103.68,Included in per diem,102.6,Included in ER Case rate,102.6,102.6, 105.84 ,97.2
42010166,EAP,CPT® 97597,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Rmvl Devital Tis 20 Cm/<,1,170.00, 161.50 ,166.6, 161.50 , 164.90 , 161.50 ,Current Medicare Rates,164.9,163.2,Included in per diem,161.5,Included in ER Case rate,161.5,161.5, 166.60 ,153
42010072,EAP,CPT® 29200,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Strapping Of Chest Thorax,1,142.00, 134.90 ,139.16, 134.90 , 137.74 , 134.90 ,Current Medicare Rates,137.74,136.32,Included in per diem,134.9,Included in ER Case rate,134.9,134.9, 139.16 ,127.8
42010074,EAP,CPT® 29260,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Strapping Of Elbow Or Wrist,1,159.00, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,Included in per diem,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
42010076,EAP,CPT® 29280,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Strapping Of Hand Or Finger,1,156.00, 148.20 ,152.88, 148.20 , 151.32 , 148.20 ,Current Medicare Rates,151.32,149.76,Included in per diem,148.2,Included in ER Case rate,148.2,148.2, 152.88 ,140.4
42010073,EAP,CPT® 29240,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Strapping Shoulder,1,184.00, 174.80 ,180.32, 174.80 , 178.48 , 174.80 ,Current Medicare Rates,178.48,176.64,Included in per diem,174.8,Included in ER Case rate,174.8,174.8, 180.32 ,165.6
42010160,EAP,CPT® 97530,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Therapeutic Activities, Ea 15 Min",1,113.00, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
42010131,EAP,CPT® 97110,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Therapeutic Exercises, Ea 15 Min",1,113.00, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,Included in per diem,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
42010127,EAP,CPT® 97035,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Ultrasound Therapy, Ea 15 Min",1,80.00, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
42010165,EAP,CPT® 97542,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,"Hc Wheelchair Mngment Training, Ea 15 Min",1,160.00, 152.00 ,156.8, 152.00 , 155.20 , 152.00 ,Current Medicare Rates,155.2,153.6,Included in per diem,152,Included in ER Case rate,152,152, 156.80 ,144
42010117,EAP,CPT® 97022,,0420 - PHYSICAL THERAPY - GENERAL CLASSIFICATION,Hc Whirlpool Therapy,1,77.00, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,Included in per diem,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
42410067,EAP,CPT® 97162,,0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION,Hc Pt Evaluation  Mod Complex,1,238.00, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
42410068,EAP,CPT® 97163,,0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION,Hc Pt Evaluation High Complex,1,238.00, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
42410066,EAP,CPT® 97161,,0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION,Hc Pt Evaluation Low Complex,1,238.00, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
42410069,EAP,CPT® 97164,,0424 - PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION,Hc Pt Re-evaluation Established Plan Of Care,1,238.00, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
43010004,EAP,CPT® 97018,,0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION,Hc Paraffin Bath Therapy,1,67.00, 63.65 ,65.66, 63.65 , 64.99 , 63.65 ,Current Medicare Rates,64.99,64.32,Included in per diem,63.65,Included in ER Case rate,63.65,63.65, 65.66 ,60.3
43010010,EAP,CPT® 97535,,0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION,Hc Self Care Mngment Training - Comp,1,114.00, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
43010008,EAP,CPT® 97535,,0430 - OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION,"Hc Self Care Mngment Training, Ea 15 Min",1,114.00, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
43410047,EAP,CPT® 97167,,0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION,Hc Ot Evaluation High Complex,1,238.00, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
43410045,EAP,CPT® 97165,,0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION,Hc Ot Evaluation Low Complex,1,238.00, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
43410046,EAP,CPT® 97166,,0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION,Hc Ot Evaluation Mod Complexity,1,238.00, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,Included in ER Case rate,226.1,226.1, 233.24 ,214.2
43410048,EAP,CPT® 97168,,0434 - OCCUPATIONAL THERAPY - EVALUATION OR REEVALUATION,Hc Ot Re-evaluation Established Plan Of Care,1,250.00, 237.50 ,245, 237.50 , 242.50 , 237.50 ,Current Medicare Rates,242.5,240,Included in per diem,237.5,Included in ER Case rate,237.5,237.5, 245.00 ,225
44010138,EAP,92521,,0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION,HC EVALUATION OF SPEECH FLUENCY,1,306.00, 290.70 ,299.88, 290.70 , 296.82 , 290.70 ,Current Medicare Rates,296.82,293.76,Included in per diem,290.7,Included in ER Case rate,290.7,290.7, 299.88 ,275.4
44010042,EAP,92526,,0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION,HC ORAL FUNCTION THERAPY,1,338.00, 321.10 ,331.24, 321.10 , 327.86 , 321.10 ,Current Medicare Rates,327.86,324.48,Included in per diem,321.1,Included in ER Case rate,321.1,321.1, 331.24 ,304.2
44010024,EAP,92508,,0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION,HC SPEECH/HEARING THERAPY - GRP,1,78.00, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,Included in per diem,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
44010006,EAP,92507,,0440 - SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION,HC SPEECH/HEARING THERAPY - INDIV 15 MIN,1,251.00, 238.45 ,245.98, 238.45 , 243.47 , 238.45 ,Current Medicare Rates,243.47,240.96,Included in per diem,238.45,Included in ER Case rate,238.45,238.45, 245.98 ,225.9
44010074,EAP,96105,,0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - Eval or Reevaluation,"HC ASSESSMENT OF APHASIA, PER HOUR",1,324.00, 307.80 ,317.52, 307.80 , 314.28 , 307.80 ,Current Medicare Rates,314.28,311.04,Included in per diem,307.8,Included in ER Case rate,307.8,307.8, 317.52 ,291.6
44010127,EAP,92524,,0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - Eval or Reevaluation,HC BEHAVRAL QUALIT ANALYS VOICE,1,499.00, 474.05 ,489.02, 474.05 , 484.03 , 474.05 ,Current Medicare Rates,484.03,479.04,Included in per diem,474.05,Included in ER Case rate,474.05,474.05, 489.02 ,449.1
44410064,EAP,92522,,0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - Eval or Reevaluation,HC EVALUATE SPEECH PRODUCTION,1,424.00, 402.80 ,415.52, 402.80 , 411.28 , 402.80 ,Current Medicare Rates,411.28,407.04,Included in per diem,402.8,Included in ER Case rate,402.8,402.8, 415.52 ,381.6
44410026,EAP,92610,,0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - Eval or Reevaluation,HC EVALUATE SWALLOWING FUNCTION,1,264.00, 250.80 ,258.72, 250.80 , 256.08 , 250.80 ,Current Medicare Rates,256.08,253.44,Included in per diem,250.8,Included in ER Case rate,250.8,250.8, 258.72 ,237.6
44010126,EAP,92523,,0444 - SPEECH THERAPY - LANGUAGE PATHOLOGY - Eval or Reevaluation,HC SPEECH SOUND LANG COMPREHEN,1,575.00, 546.25 ,563.5, 546.25 , 557.75 , 546.25 ,Current Medicare Rates,557.75,552,Included in per diem,546.25,Included in ER Case rate,546.25,546.25, 563.50 ,517.5
45014046,EAP,CPT® 49082,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Abd Paracentesis W/o Imag Guid Cdm,1,705.00, 669.75 ,690.9, 669.75 , 683.85 , 669.75 ,Current Medicare Rates,683.85,676.8,Included in per diem,669.75,"$3,950 per Case",669.75,669.75, 690.90 ,634.5
45010239,EAP,CPT® 26951,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Amputate Finger/thumb Single W/direct Closure Cdm,1,969.00, 920.55 ,949.62, 920.55 , 939.93 , 920.55 ,Current Medicare Rates,939.93,930.24,Included in per diem,920.55,"$3,950 per Case",920.55,920.55, 949.62 ,872.1
45010250,EAP,CPT® 26952,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Amputate Finger/thumb Single W/local Adv Flaps Cdm,1,"2,401.00"," 2,280.95 ",2352.98," 2,280.95 "," 2,328.97 "," 2,280.95 ",Current Medicare Rates,2328.97,2304.96,Included in per diem,2280.95,"$3,950 per Case",2280.95,2280.95," 2,352.98 ",2160.9
45013127,EAP,CPT® 29505,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Application Long Leg Splint Cdm,1,314.00, 298.30 ,307.72, 298.30 , 304.58 , 298.30 ,Current Medicare Rates,304.58,301.44,Included in per diem,298.3,"$3,950 per Case",298.3,298.3, 307.72 ,282.6
45013112,EAP,CPT® 29130,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Application Of Finger Splint Static Cdm,1,124.00, 117.80 ,121.52, 117.80 , 120.28 , 117.80 ,Current Medicare Rates,120.28,119.04,Included in per diem,117.8,"$3,950 per Case",117.8,117.8, 121.52 ,111.6
45013121,EAP,CPT® 29345,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Application Of Long Leg Cast Cdm,1,550.00, 522.50 ,539, 522.50 , 533.50 , 522.50 ,Current Medicare Rates,533.5,528,Included in per diem,522.5,"$3,950 per Case",522.5,522.5, 539.00 ,495
45010825,EAP,CPT® 29126,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Application Short Arm Splint Dynamic Cdm,1,183.00, 173.85 ,179.34, 173.85 , 177.51 , 173.85 ,Current Medicare Rates,177.51,175.68,Included in per diem,173.85,"$3,950 per Case",173.85,173.85, 179.34 ,164.7
45013124,EAP,CPT® 29425,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Apply Short Walking Leg Cast Cdm,1,463.00, 439.85 ,453.74, 439.85 , 449.11 , 439.85 ,Current Medicare Rates,449.11,444.48,Included in per diem,439.85,"$3,950 per Case",439.85,439.85, 453.74 ,416.7
45014053,EAP,CPT® 69205,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Clear Outer Ear Canal Cdm,1,675.00, 641.25 ,661.5, 641.25 , 654.75 , 641.25 ,Current Medicare Rates,654.75,648,Included in per diem,641.25,"$3,950 per Case",641.25,641.25, 661.50 ,607.5
45010489,EAP,CPT® 69200,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Clear Outer Ear Canal W/o General Anesthesia Cdm,1,204.00, 193.80 ,199.92, 193.80 , 197.88 , 193.80 ,Current Medicare Rates,197.88,195.84,Included in per diem,193.8,"$3,950 per Case",193.8,193.8, 199.92 ,183.6
45013025,EAP,CPT® 27842,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Ankle Dislocation W/anesth Cdm,1,1637," 1,555.15 ",1604.26," 1,555.15 "," 1,587.89 "," 1,555.15 ",Current Medicare Rates,1587.89,1571.52,Included in per diem,1555.15,"$3,950 per Case",1555.15,1555.15," 1,604.26 ",1473.3
45001299,EAP,CPT® 28490,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Big Toe Fracture W/o Manip Cdm,1,484.00, 459.80 ,474.32, 459.80 , 469.48 , 459.80 ,Current Medicare Rates,469.48,464.64,Included in per diem,459.8,"$3,950 per Case",459.8,459.8, 474.32 ,435.6
45010163,EAP,CPT® 27552,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Knee Dislocation W/anesth Cdm,1,"3,418.00"," 3,247.10 ",3349.64," 3,247.10 "," 3,315.46 "," 3,247.10 ",Current Medicare Rates,3315.46,3281.28,Included in per diem,3247.1,"$3,950 per Case",3247.1,3247.1," 3,349.64 ",3076.2
45010165,EAP,CPT® 27560,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Knee Dislocation W/o Anesth Cdm,1,"1,062.00"," 1,008.90 ",1040.76," 1,008.90 "," 1,030.14 "," 1,008.90 ",Current Medicare Rates,1030.14,1019.52,Included in per diem,1008.9,"$3,950 per Case",1008.9,1008.9," 1,040.76 ",955.8
45013018,EAP,CPT® 27824,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Lower Leg Fracture W/o Manip Cdm,1,"1,251.00"," 1,188.45 ",1225.98," 1,188.45 "," 1,213.47 "," 1,188.45 ",Current Medicare Rates,1213.47,1200.96,Included in per diem,1188.45,"$3,950 per Case",1188.45,1188.45," 1,225.98 ",1125.9
45010749,EAP,CPT® 24640,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Of Radial Head Subluxation W/manip Cdm,1,484.00, 459.80 ,474.32, 459.80 , 469.48 , 459.80 ,Current Medicare Rates,469.48,464.64,Included in per diem,459.8,"$3,950 per Case",459.8,459.8, 474.32 ,435.6
45010168,EAP,CPT® 27562,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Patella Dislocation W/anseth Cdm,1,"1,768.00"," 1,679.60 ",1732.64," 1,679.60 "," 1,714.96 "," 1,679.60 ",Current Medicare Rates,1714.96,1697.28,Included in per diem,1679.6,"$3,950 per Case",1679.6,1679.6," 1,732.64 ",1591.2
45010496,EAP,CPT® 27520,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Patellar Fracture W/o Manipulation Cdm,1,"1,175.00"," 1,116.25 ",1151.5," 1,116.25 "," 1,139.75 "," 1,116.25 ",Current Medicare Rates,1139.75,1128,Included in per diem,1116.25,"$3,950 per Case",1116.25,1116.25," 1,151.50 ",1057.5
45010176,EAP,CPT® 27750,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Tib Shaft Fracture W/o Manip Cdm,1,1514," 1,438.30 ",1483.72," 1,438.30 "," 1,468.58 "," 1,438.30 ",Current Medicare Rates,1468.58,1453.44,Included in per diem,1438.3,"$3,950 per Case",1438.3,1438.3," 1,483.72 ",1362.6
45010499,EAP,CPT® 27530,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Tibial Fracture Proximal W/o Manip Cdm,1,"1,457.00"," 1,384.15 ",1427.86," 1,384.15 "," 1,413.29 "," 1,384.15 ",Current Medicare Rates,1413.29,1398.72,Included in per diem,1384.15,"$3,950 per Case",1384.15,1384.15," 1,427.86 ",1311.3
45010179,EAP,CPT® 27752,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Tibial Fracture W/manipulation Cdm,1,"2,179.00"," 2,070.05 ",2135.42," 2,070.05 "," 2,113.63 "," 2,070.05 ",Current Medicare Rates,2113.63,2091.84,Included in per diem,2070.05,"$3,950 per Case",2070.05,2070.05," 2,135.42 ",1961.1
45013091,EAP,CPT® 28660,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treat Toe Dislocation Cdm,1,447.00, 424.65 ,438.06, 424.65 , 433.59 , 424.65 ,Current Medicare Rates,433.59,429.12,Included in per diem,424.65,"$3,950 per Case",424.65,424.65, 438.06 ,402.3
45010328,EAP,CPT® 21337,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treatment Nasal Septal Fracture Cdm,1,1235," 1,173.25 ",1210.3," 1,173.25 "," 1,197.95 "," 1,173.25 ",Current Medicare Rates,1197.95,1185.6,Included in per diem,1173.25,"$3,950 per Case",1173.25,1173.25," 1,210.30 ",1111.5
45013021,EAP,CPT® 27840,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treatment Of Ankle Dislocation W/o Anesth Cdm,1,"1,284.00"," 1,219.80 ",1258.32," 1,219.80 "," 1,245.48 "," 1,219.80 ",Current Medicare Rates,1245.48,1232.64,Included in per diem,1219.8,"$3,950 per Case",1219.8,1219.8," 1,258.32 ",1155.6
45010198,EAP,CPT® 27786,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treatment Of Ankle Fracture W/o Manip Cdm,1,1096," 1,041.20 ",1074.08," 1,041.20 "," 1,063.12 "," 1,041.20 ",Current Medicare Rates,1063.12,1052.16,Included in per diem,1041.2,"$3,950 per Case",1041.2,1041.2," 1,074.08 ",986.4
45013002,EAP,CPT® 27788,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Treatment Of Ankle Fx Dis Fibula W/manip Cdm,1,"1,446.00"," 1,373.70 ",1417.08," 1,373.70 "," 1,402.62 "," 1,373.70 ",Current Medicare Rates,1402.62,1388.16,Included in per diem,1373.7,"$3,950 per Case",1373.7,1373.7," 1,417.08 ",1301.4
45010974,EAP,CPT® 26742,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Articular Fracture W/manip Cdm,1,1132," 1,075.40 ",1109.36," 1,075.40 "," 1,098.04 "," 1,075.40 ",Current Medicare Rates,1098.04,1086.72,Included in per diem,1075.4,"$3,950 per Case",1075.4,1075.4," 1,109.36 ",1018.8
45010963,EAP,CPT® 26740,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Articular Fracture W/o Manip Cdm,1,832.00, 790.40 ,815.36, 790.40 , 807.04 , 790.40 ,Current Medicare Rates,807.04,798.72,Included in per diem,790.4,"$3,950 per Case",790.4,790.4, 815.36 ,748.8
45010996,EAP,CPT® 26755,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Distal Phalang Fx Finger/thumb W/manip Tuft Fx Cdm,1,783, 743.85 ,767.34, 743.85 , 759.51 , 743.85 ,Current Medicare Rates,759.51,751.68,Included in per diem,743.85,"$3,950 per Case",743.85,743.85, 767.34 ,704.7
45010986,EAP,CPT® 26750,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Distal Phalangeal Fracture Finger/thumb W/o Manip Ea -tuft Cdm,1,587.00, 557.65 ,575.26, 557.65 , 569.39 , 557.65 ,Current Medicare Rates,569.39,563.52,Included in per diem,557.65,"$3,950 per Case",557.65,557.65, 575.26 ,528.3
45010852,EAP,CPT® 26775,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Finger Dislocation W/anesth Cdm,1,970, 921.50 ,950.6, 921.50 , 940.90 , 921.50 ,Current Medicare Rates,940.9,931.2,Included in per diem,921.5,"$3,950 per Case",921.5,921.5, 950.60 ,873
45010851,EAP,CPT® 26770,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Finger Dislocation W/o Anesth Cdm,1,784.00, 744.80 ,768.32, 744.80 , 760.48 , 744.80 ,Current Medicare Rates,760.48,752.64,Included in per diem,744.8,"$3,950 per Case",744.8,744.8, 768.32 ,705.6
45010267,EAP,CPT® 27252,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Hip Dislocation W/anesth Cdm,1,"2,770.00"," 2,631.50 ",2714.6," 2,631.50 "," 2,686.90 "," 2,631.50 ",Current Medicare Rates,2686.9,2659.2,Included in per diem,2631.5,"$3,950 per Case",2631.5,2631.5," 2,714.60 ",2493
45010263,EAP,CPT® 27250,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Hip Dislocation W/o Anesth Cdm,1,"1,792.00"," 1,702.40 ",1756.16," 1,702.40 "," 1,738.24 "," 1,702.40 ",Current Medicare Rates,1738.24,1720.32,Included in per diem,1702.4,"$3,950 per Case",1702.4,1702.4," 1,756.16 ",1612.8
45010192,EAP,CPT® 27780,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Of Fibula Fracture Prox W/o Manip Cdm,1,937.00, 890.15 ,918.26, 890.15 , 908.89 , 890.15 ,Current Medicare Rates,908.89,899.52,Included in per diem,890.15,"$3,950 per Case",890.15,890.15, 918.26 ,843.3
45010185,EAP,CPT® 27762,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Of Medial Malleolus Fracture W/manip Cdm,1,1636," 1,554.20 ",1603.28," 1,554.20 "," 1,586.92 "," 1,554.20 ",Current Medicare Rates,1586.92,1570.56,Included in per diem,1554.2,"$3,950 per Case",1554.2,1554.2," 1,603.28 ",1472.4
45010182,EAP,CPT® 27760,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Of Medial Malleolus Fracture W/o Manip Cdm,1,1138," 1,081.10 ",1115.24," 1,081.10 "," 1,103.86 "," 1,081.10 ",Current Medicare Rates,1103.86,1092.48,Included in per diem,1081.1,"$3,950 per Case",1081.1,1081.1," 1,115.24 ",1024.2
45013166,EAP,CPT® 27830,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Of Porc Tibiofibular Joint Dislocation W/o Anesth  Cdm,1,"1,073.00"," 1,019.35 ",1051.54," 1,019.35 "," 1,040.81 "," 1,019.35 ",Current Medicare Rates,1040.81,1030.08,Included in per diem,1019.35,"$3,950 per Case",1019.35,1019.35," 1,051.54 ",965.7
45010943,EAP,CPT® 26725,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Phalangeal Shaft Fracture Finger Or Thumb W/manip Ea Cdm,1,"1,003.00", 952.85 ,982.94, 952.85 , 972.91 , 952.85 ,Current Medicare Rates,972.91,962.88,Included in per diem,952.85,"$3,950 per Case",952.85,952.85, 982.94 ,902.7
45010929,EAP,CPT® 26720,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closed Tx Phalangeal Shaft Fracture Finger Or Thumb W/o Manip Ea Cdm,1,587, 557.65 ,575.26, 557.65 , 569.39 , 557.65 ,Current Medicare Rates,569.39,563.52,Included in per diem,557.65,"$3,950 per Case",557.65,557.65, 575.26 ,528.3
45010370,EAP,CPT® 12020,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Closure Of Split Wound Simple Closure Cdm,1,691, 656.45 ,677.18, 656.45 , 670.27 , 656.45 ,Current Medicare Rates,670.27,663.36,Included in per diem,656.45,"$3,950 per Case",656.45,656.45, 677.18 ,621.9
45010140,EAP,CPT® 27198,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Clsd Tx Pelvic Fx W/manip Cdm,1,3578," 3,399.10 ",3506.44," 3,399.10 "," 3,470.66 "," 3,399.10 ",Current Medicare Rates,3470.66,3434.88,Included in per diem,3399.1,"$3,950 per Case",3399.1,3399.1," 3,506.44 ",3220.2
45010921,EAP,CPT® 26670,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Cltx Carpo/metacarpl Dislo Other Than Thmb Manj Ea W/o Anes Cdm,1,1025, 973.75 ,1004.5, 973.75 , 994.25 , 973.75 ,Current Medicare Rates,994.25,984,Included in per diem,973.75,"$3,950 per Case",973.75,973.75," 1,004.50 ",922.5
45013090,EAP,CPT® 28635,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Cltx Metatarsophlngl Jt Dislc Req Anes Cdm,1,741.00, 703.95 ,726.18, 703.95 , 718.77 , 703.95 ,Current Medicare Rates,718.77,711.36,Included in per diem,703.95,"$3,950 per Case",703.95,703.95, 726.18 ,666.9
45013087,EAP,CPT® 28630,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Cltx Metatarsophlngl Jt Dislc W/o Anes Cdm,1,201, 190.95 ,196.98, 190.95 , 194.97 , 190.95 ,Current Medicare Rates,194.97,192.96,Included in per diem,190.95,"$3,950 per Case",190.95,190.95, 196.98 ,180.9
45010190,EAP,CPT® 27768,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Cltx Post Ankle Fx W/manipulation Cdm,1,1198," 1,138.10 ",1174.04," 1,138.10 "," 1,162.06 "," 1,138.10 ",Current Medicare Rates,1162.06,1150.08,Included in per diem,1138.1,"$3,950 per Case",1138.1,1138.1," 1,174.04 ",1078.2
45010189,EAP,CPT® 27767,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Cltx Post Ankle Fx W/o Manip Cdm,1,1198," 1,138.10 ",1174.04," 1,138.10 "," 1,162.06 "," 1,138.10 ",Current Medicare Rates,1162.06,1150.08,Included in per diem,1138.1,"$3,950 per Case",1138.1,1138.1," 1,174.04 ",1078.2
45010598,EAP,CPT® 23665,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Cltx Shoulder Dislc W/fx Humeral Tubrst W/manj Cdm,1,1168," 1,109.60 ",1144.64," 1,109.60 "," 1,132.96 "," 1,109.60 ",Current Medicare Rates,1132.96,1121.28,Included in per diem,1109.6,"$3,950 per Case",1109.6,1109.6," 1,144.64 ",1051.2
45010317,EAP,CPT® 10180,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Complex Drainage Wound - Cmplx Cdm,1,907, 861.65 ,888.86, 861.65 , 879.79 , 861.65 ,Current Medicare Rates,879.79,870.72,Included in per diem,861.65,"$3,950 per Case",861.65,861.65, 888.86 ,816.3
45010030,EAP,CPT® 30903,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Control Of Nosebleed Complex Cdm,1,523, 496.85 ,512.54, 496.85 , 507.31 , 496.85 ,Current Medicare Rates,507.31,502.08,Included in per diem,496.85,"$3,950 per Case",496.85,496.85, 512.54 ,470.7
45013183,EAP,CPT® 30905,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Control Of Nosebleed Posterior Cdm,1,879, 835.05 ,861.42, 835.05 , 852.63 , 835.05 ,Current Medicare Rates,852.63,843.84,Included in per diem,835.05,"$3,950 per Case",835.05,835.05, 861.42 ,791.1
45010028,EAP,CPT® 30901,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Control Of Nosebleed Simple Cdm,1,408, 387.60 ,399.84, 387.60 , 395.76 , 387.60 ,Current Medicare Rates,395.76,391.68,Included in per diem,387.6,"$3,950 per Case",387.6,387.6, 399.84 ,367.2
45010221,EAP,CPT® 99292,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Critical Care Addl 30 Min Cdm,1,665, 631.75 ,651.7, 631.75 , 645.05 , 631.75 ,Current Medicare Rates,645.05,638.4,Included in per diem,631.75,"$3,950 per Case",631.75,631.75, 651.70 ,598.5
45010094,EAP,CPT® 99291,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Critical Care First Hour Cdm,1,769, 730.55 ,753.62, 730.55 , 745.93 , 730.55 ,Current Medicare Rates,745.93,738.24,Included in per diem,730.55,"$3,950 per Case",730.55,730.55, 753.62 ,692.1
45013185,EAP,CPT® 30906,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Ctrl Nsl Hemrrg Pst Nasal Packs&/cautery Subsq Cdm,1,741, 703.95 ,726.18, 703.95 , 718.77 , 703.95 ,Current Medicare Rates,718.77,711.36,Included in per diem,703.95,"$3,950 per Case",703.95,703.95, 726.18 ,666.9
45010327,EAP,CPT® 11044,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Deb Bone 20 Sq Cm/< Cdm,1,1457," 1,384.15 ",1427.86," 1,384.15 "," 1,413.29 "," 1,384.15 ",Current Medicare Rates,1413.29,1398.72,Included in per diem,1384.15,"$3,950 per Case",1384.15,1384.15," 1,427.86 ",1311.3
45010325,EAP,CPT® 11043,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Deb Musc/fascia 20 Sq Cm/< Cdm,1,995, 945.25 ,975.1, 945.25 , 965.15 , 945.25 ,Current Medicare Rates,965.15,955.2,Included in per diem,945.25,"$3,950 per Case",945.25,945.25, 975.10 ,895.5
45010321,EAP,CPT® 11012,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Deb Skin Bone At Fx Site Cdm,1,2487," 2,362.65 ",2437.26," 2,362.65 "," 2,412.39 "," 2,362.65 ",Current Medicare Rates,2412.39,2387.52,Included in per diem,2362.65,"$3,950 per Case",2362.65,2362.65," 2,437.26 ",2238.3
45010324,EAP,CPT® 11042,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Deb Subq Tissue 20 Sq Cm/< - Debride Skin Cdm,1,946, 898.70 ,927.08, 898.70 , 917.62 , 898.70 ,Current Medicare Rates,917.62,908.16,Included in per diem,898.7,"$3,950 per Case",898.7,898.7, 927.08 ,851.4
45010318,EAP,CPT® 11000,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Debride Infected Skin Cdm,1,182, 172.90 ,178.36, 172.90 , 176.54 , 172.90 ,Current Medicare Rates,176.54,174.72,Included in per diem,172.9,"$3,950 per Case",172.9,172.9, 178.36 ,163.8
45010346,EAP,CPT® 11720,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Debride Nail 1-5 Cdm,1,107.00, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,Included in per diem,101.65,"$3,950 per Case",101.65,101.65, 104.86 ,96.3
45010320,EAP,CPT® 11010,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,HC ED DEBRIDE SKIN AT FX SITE CDM,1,743.00, 705.85 ,728.14, 705.85 , 720.71 , 705.85 ,Current Medicare Rates,720.71,713.28,Included in per diem,705.85,"$3,950 per Case",705.85,705.85, 728.14 ,668.7
45010119,EAP,CPT® 59414,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Deliver Placenta Cdm,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,"$3,950 per Case",0.01,0.01, 0.01 ,0.009
45010414,EAP,CPT® 46600,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Diagnostic Anoscopy Cdm,1,209, 198.55 ,204.82, 198.55 , 202.73 , 198.55 ,Current Medicare Rates,202.73,200.64,Included in per diem,198.55,"$3,950 per Case",198.55,198.55, 204.82 ,188.1
45010138,EAP,CPT® 25606,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Distal Radial Fracture Cdm,1,4122," 3,915.90 ",4039.56," 3,915.90 "," 3,998.34 "," 3,915.90 ",Current Medicare Rates,3998.34,3957.12,Included in per diem,3915.9,"$3,950 per Case",3915.9,3915.9," 4,039.56 ",3709.8
45010609,EAP,CPT® 11740,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drain Blood From Under Nail Cdm,1,145, 137.75 ,142.1, 137.75 , 140.65 , 137.75 ,Current Medicare Rates,140.65,139.2,Included in per diem,137.75,"$3,950 per Case",137.75,137.75, 142.10 ,130.5
45010557,EAP,CPT® 21501,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drain Neck/chest Lesion - Lesion Drain Cdm,1,1219," 1,158.05 ",1194.62," 1,158.05 "," 1,182.43 "," 1,158.05 ",Current Medicare Rates,1182.43,1170.24,Included in per diem,1158.05,"$3,950 per Case",1158.05,1158.05," 1,194.62 ",1097.1
45010604,EAP,CPT® 23931,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Arm Bursa Cdm,1,1067," 1,013.65 ",1045.66," 1,013.65 "," 1,034.99 "," 1,013.65 ",Current Medicare Rates,1034.99,1024.32,Included in per diem,1013.65,"$3,950 per Case",1013.65,1013.65," 1,045.66 ",960.3
45010482,EAP,CPT® 67700,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Eyelid Abscess Cdm,1,798, 758.10 ,782.04, 758.10 , 774.06 , 758.10 ,Current Medicare Rates,774.06,766.08,Included in per diem,758.1,"$3,950 per Case",758.1,758.1, 782.04 ,718.2
45010316,EAP,CPT® 10140,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Hema/fluid Cdm,1,315, 299.25 ,308.7, 299.25 , 305.55 , 299.25 ,Current Medicare Rates,305.55,302.4,Included in per diem,299.25,"$3,950 per Case",299.25,299.25, 308.70 ,283.5
45010443,EAP,CPT® 57020,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Pelvic Fluid Cdm,1,564, 535.80 ,552.72, 535.80 , 547.08 , 535.80 ,Current Medicare Rates,547.08,541.44,Included in per diem,535.8,"$3,950 per Case",535.8,535.8, 552.72 ,507.6
45010311,EAP,CPT® 10080,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Pilonidal Cyst Simple Cdm,1,337, 320.15 ,330.26, 320.15 , 326.89 , 320.15 ,Current Medicare Rates,326.89,323.52,Included in per diem,320.15,"$3,950 per Case",320.15,320.15, 330.26 ,303.3
45010310,EAP,CPT® 10061,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Skin Abscess Complicated Or Multiple Cdm,1,510, 484.50 ,499.8, 484.50 , 494.70 , 484.50 ,Current Medicare Rates,494.7,489.6,Included in per diem,484.5,"$3,950 per Case",484.5,484.5, 499.80 ,459
45010309,EAP,CPT® 10060,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Skin Abscess Simple Or Single Cdm,1,305, 289.75 ,298.9, 289.75 , 295.85 , 289.75 ,Current Medicare Rates,295.85,292.8,Included in per diem,289.75,"$3,950 per Case",289.75,289.75, 298.90 ,274.5
45013232,EAP,CPT® 42700,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Drainage Of Tonsil Abscess Cdm,1,484, 459.80 ,474.32, 459.80 , 469.48 , 459.80 ,Current Medicare Rates,469.48,464.64,Included in per diem,459.8,"$3,950 per Case",459.8,459.8, 474.32 ,435.6
45010521,EAP,CPT® 16030,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Dress/debrid P-thick Burn L >10% Tbsa Cdm,1,471, 447.45 ,461.58, 447.45 , 456.87 , 447.45 ,Current Medicare Rates,456.87,452.16,Included in per diem,447.45,"$3,950 per Case",447.45,447.45, 461.58 ,423.9
45010520,EAP,CPT® 16025,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Dress/debrid P-thick Burn M 5-10% Tbsa Cdm,1,372, 353.40 ,364.56, 353.40 , 360.84 , 353.40 ,Current Medicare Rates,360.84,357.12,Included in per diem,353.4,"$3,950 per Case",353.4,353.4, 364.56 ,334.8
45010519,EAP,CPT® 16020,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Dress/debrid P-thick Burn S <5% Tbsa Cdm,1,209, 198.55 ,204.82, 198.55 , 202.73 , 198.55 ,Current Medicare Rates,202.73,200.64,Included in per diem,198.55,"$3,950 per Case",198.55,198.55, 204.82 ,188.1
45010204,EAP,CPT® 99281,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Emergency Dept Visit Level I Cdm,1,294, 279.30 ,288.12, 279.30 , 285.18 , 279.30 ,Current Medicare Rates,285.18,282.24,Included in per diem,279.3,"$3,950 per Case",279.3,279.3, 288.12 ,264.6
45010207,EAP,CPT® 99282,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Emergency Dept Visit Level Ii Cdm,1,331, 314.45 ,324.38, 314.45 , 321.07 , 314.45 ,Current Medicare Rates,321.07,317.76,Included in per diem,314.45,"$3,950 per Case",314.45,314.45, 324.38 ,297.9
45010210,EAP,CPT® 99283,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Emergency Dept Visit Level Iii Cdm,1,570, 541.50 ,558.6, 541.50 , 552.90 , 541.50 ,Current Medicare Rates,552.9,547.2,Included in per diem,541.5,"$3,950 per Case",541.5,541.5, 558.60 ,513
45010213,EAP,CPT® 99284,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Emergency Dept Visit Level Iv Cdm,1,852, 809.40 ,834.96, 809.40 , 826.44 , 809.40 ,Current Medicare Rates,826.44,817.92,Included in per diem,809.4,"$3,950 per Case",809.4,809.4, 834.96 ,766.8
45010216,EAP,CPT® 99285,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Emergency Dept Visit Level V Cdm,1,1339," 1,272.05 ",1312.22," 1,272.05 "," 1,298.83 "," 1,272.05 ",Current Medicare Rates,1298.83,1285.44,Included in per diem,1272.05,"$3,950 per Case",1272.05,1272.05," 1,312.22 ",1205.1
45010344,EAP,CPT® 11423,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Exc H-f-nk-sp B9+marg 2.1-3 Cdm,1,650, 617.50 ,637, 617.50 , 630.50 , 617.50 ,Current Medicare Rates,630.5,624,Included in per diem,617.5,"$3,950 per Case",617.5,617.5, 637.00 ,585
45010354,EAP,CPT® 11765,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Excision Of Nail Fold Toe Cdm,1,252, 239.40 ,246.96, 239.40 , 244.44 , 239.40 ,Current Medicare Rates,244.44,241.92,Included in per diem,239.4,"$3,950 per Case",239.4,239.4, 246.96 ,226.8
45010532,EAP,CPT® 20102,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Explore Wound Abdomen Cdm,1,2528," 2,401.60 ",2477.44," 2,401.60 "," 2,452.16 "," 2,401.60 ",Current Medicare Rates,2452.16,2426.88,Included in per diem,2401.6,"$3,950 per Case",2401.6,2401.6," 2,477.44 ",2275.2
45010533,EAP,CPT® 20103,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Explore Wound Extremity Cdm,1,1935," 1,838.25 ",1896.3," 1,838.25 "," 1,876.95 "," 1,838.25 ",Current Medicare Rates,1876.95,1857.6,Included in per diem,1838.25,"$3,950 per Case",1838.25,1838.25," 1,896.30 ",1741.5
45010511,EAP,CPT® 14350,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Filleted Finger/toe Flap Cdm,1,2556," 2,428.20 ",2504.88," 2,428.20 "," 2,479.32 "," 2,428.20 ",Current Medicare Rates,2479.32,2453.76,Included in per diem,2428.2,"$3,950 per Case",2428.2,2428.2," 2,504.88 ",2300.4
45014005,EAP,CPT® 26010,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed I+d Finger Absc-sim-fa Cdm,1,578, 549.10 ,566.44, 549.10 , 560.66 , 549.10 ,Current Medicare Rates,560.66,554.88,Included in per diem,549.1,"$3,950 per Case",549.1,549.1, 566.44 ,520.2
45010410,EAP,CPT® 46083,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Incise External Hemorrhoid Cdm,1,512, 486.40 ,501.76, 486.40 , 496.64 , 486.40 ,Current Medicare Rates,496.64,491.52,Included in per diem,486.4,"$3,950 per Case",486.4,486.4, 501.76 ,460.8
45010407,EAP,CPT® 46040,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Incision Of Rectal Abscess Cdm,1,453.60, 430.92 ,444.53, 430.92 , 439.99 , 430.92 ,Current Medicare Rates,439.99,435.46,Included in per diem,430.92,"$3,950 per Case",430.92,430.92, 444.53 ,408.24
45010518,EAP,CPT® 16000,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Initial Treatment Of Burn(s) 1st Deg Local Tx Cdm,1,190, 180.50 ,186.2, 180.50 , 184.30 , 180.50 ,Current Medicare Rates,184.3,182.4,Included in per diem,180.5,"$3,950 per Case",180.5,180.5, 186.20 ,171
45010538,EAP,CPT® 20550,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Inj Tendon Sheath/ligament Cdm,1,254, 241.30 ,248.92, 241.30 , 246.38 , 241.30 ,Current Medicare Rates,246.38,243.84,Included in per diem,241.3,"$3,950 per Case",241.3,241.3, 248.92 ,228.6
45010539,EAP,CPT® 20552,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Inj Trigger Point 1/2 Muscl Cdm,1,293, 278.35 ,287.14, 278.35 , 284.21 , 278.35 ,Current Medicare Rates,284.21,281.28,Included in per diem,278.35,"$3,950 per Case",278.35,278.35, 287.14 ,263.7
45010540,EAP,CPT® 20553,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Inject Trigger Points =/> 3 Cdm,1,562, 533.90 ,550.76, 533.90 , 545.14 , 533.90 ,Current Medicare Rates,545.14,539.52,Included in per diem,533.9,"$3,950 per Case",533.9,533.9, 550.76 ,505.8
45010236,EAP,CPT® 64505,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Injection Anes Agent Sphenopalatine Ganglion Cdm,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,"$3,950 per Case",427.5,427.5, 441.00 ,405
45010424,EAP,CPT® 51703,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Insert Bladder Cath Complex Cdm,1,427, 405.65 ,418.46, 405.65 , 414.19 , 405.65 ,Current Medicare Rates,414.19,409.92,Included in per diem,405.65,"$3,950 per Case",405.65,405.65, 418.46 ,384.3
45010308,EAP,CPT® 36680,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Insert Needle Bone Cavity Cdm,1,331, 314.45 ,324.38, 314.45 , 321.07 , 314.45 ,Current Medicare Rates,321.07,317.76,Included in per diem,314.45,"$3,950 per Case",314.45,314.45, 324.38 ,297.9
45010385,EAP,CPT® 12051,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair Face/mm <2.5 Cm Cdm,1,576, 547.20 ,564.48, 547.20 , 558.72 , 547.20 ,Current Medicare Rates,558.72,552.96,Included in per diem,547.2,"$3,950 per Case",547.2,547.2, 564.48 ,518.4
45010389,EAP,CPT® 12055,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair Face/mm 12.6 To 20.0cm Cdm,1,1408," 1,337.60 ",1379.84," 1,337.60 "," 1,365.76 "," 1,337.60 ",Current Medicare Rates,1365.76,1351.68,Included in per diem,1337.6,"$3,950 per Case",1337.6,1337.6," 1,379.84 ",1267.2
45010386,EAP,CPT® 12052,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair Face/mm 2.6 To 5.0cm Cdm,1,755, 717.25 ,739.9, 717.25 , 732.35 , 717.25 ,Current Medicare Rates,732.35,724.8,Included in per diem,717.25,"$3,950 per Case",717.25,717.25, 739.90 ,679.5
45010387,EAP,CPT® 12053,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair Face/mm 5.1 To 7.5cm Cdm,1,899, 854.05 ,881.02, 854.05 , 872.03 , 854.05 ,Current Medicare Rates,872.03,863.04,Included in per diem,854.05,"$3,950 per Case",854.05,854.05, 881.02 ,809.1
45010388,EAP,CPT® 12054,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair Face/mm 7.5 To 12.5cm Cdm,1,1096," 1,041.20 ",1074.08," 1,041.20 "," 1,063.12 "," 1,041.20 ",Current Medicare Rates,1063.12,1052.16,Included in per diem,1041.2,"$3,950 per Case",1041.2,1041.2," 1,074.08 ",986.4
45010378,EAP,CPT® 12041,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair N-hf/genit Up To 2.5cm Cdm,1,441, 418.95 ,432.18, 418.95 , 427.77 , 418.95 ,Current Medicare Rates,427.77,423.36,Included in per diem,418.95,"$3,950 per Case",418.95,418.95, 432.18 ,396.9
45010382,EAP,CPT® 12045,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair N-hg/genit 12.6 To 20.0cm Cdm,1,979, 930.05 ,959.42, 930.05 , 949.63 , 930.05 ,Current Medicare Rates,949.63,939.84,Included in per diem,930.05,"$3,950 per Case",930.05,930.05, 959.42 ,881.1
45010380,EAP,CPT® 12042,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair N-hg/genit 2.6 To 7.5cm Cdm,1,659, 626.05 ,645.82, 626.05 , 639.23 , 626.05 ,Current Medicare Rates,639.23,632.64,Included in per diem,626.05,"$3,950 per Case",626.05,626.05, 645.82 ,593.1
45010383,EAP,CPT® 12046,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair N-hg/genit 20.1-30.0cm Cdm,1,1155," 1,097.25 ",1131.9," 1,097.25 "," 1,120.35 "," 1,097.25 ",Current Medicare Rates,1120.35,1108.8,Included in per diem,1097.25,"$3,950 per Case",1097.25,1097.25," 1,131.90 ",1039.5
45010381,EAP,CPT® 12044,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair N-hg/genit 7.6 To 12.5cm Cdm,1,816, 775.20 ,799.68, 775.20 , 791.52 , 775.20 ,Current Medicare Rates,791.52,783.36,Included in per diem,775.2,"$3,950 per Case",775.2,775.2, 799.68 ,734.4
45010375,EAP,CPT® 12035,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair S/tr/ext 12.6 To 20.0cm Cdm,1,963, 914.85 ,943.74, 914.85 , 934.11 , 914.85 ,Current Medicare Rates,934.11,924.48,Included in per diem,914.85,"$3,950 per Case",914.85,914.85, 943.74 ,866.7
45010373,EAP,CPT® 12032,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair S/tr/ext 2.6 To 7.5cm Cdm,1,639, 607.05 ,626.22, 607.05 , 619.83 , 607.05 ,Current Medicare Rates,619.83,613.44,Included in per diem,607.05,"$3,950 per Case",607.05,607.05, 626.22 ,575.1
45010376,EAP,CPT® 12036,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair S/tr/ext 20.1 To 30.0cm Cdm,1,1155," 1,097.25 ",1131.9," 1,097.25 "," 1,120.35 "," 1,097.25 ",Current Medicare Rates,1120.35,1108.8,Included in per diem,1097.25,"$3,950 per Case",1097.25,1097.25," 1,131.90 ",1039.5
45010374,EAP,CPT® 12034,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair S/tr/ext 7.6 To 12.5cm Cdm,1,771, 732.45 ,755.58, 732.45 , 747.87 , 732.45 ,Current Medicare Rates,747.87,740.16,Included in per diem,732.45,"$3,950 per Case",732.45,732.45, 755.58 ,693.9
45010372,EAP,CPT® 12031,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Intmd Wnd Repair S/tr/ext Up To 2.5cm Cdm,1,445, 422.75 ,436.1, 422.75 , 431.65 , 422.75 ,Current Medicare Rates,431.65,427.2,Included in per diem,422.75,"$3,950 per Case",422.75,422.75, 436.10 ,400.5
45010423,EAP,CPT® 51700,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Irrigation Of Bladder Cdm,1,334, 317.30 ,327.32, 317.30 , 323.98 , 317.30 ,Current Medicare Rates,323.98,320.64,Included in per diem,317.3,"$3,950 per Case",317.3,317.3, 327.32 ,300.6
45013096,EAP,CPT® 29065,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Long Arm Cast Application Cdm,1,352, 334.40 ,344.96, 334.40 , 341.44 , 334.40 ,Current Medicare Rates,341.44,337.92,Included in per diem,334.4,"$3,950 per Case",334.4,334.4, 344.96 ,316.8
45013106,EAP,CPT® 29105,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Long Arm Splint Application Cdm,1,314, 298.30 ,307.72, 298.30 , 304.58 , 298.30 ,Current Medicare Rates,304.58,301.44,Included in per diem,298.3,"$3,950 per Case",298.3,298.3, 307.72 ,282.6
45010109,EAP,CPT® 24300,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Manipulate Elbow W/anesth Cdm,1,1413," 1,342.35 ",1384.74," 1,342.35 "," 1,370.61 "," 1,342.35 ",Current Medicare Rates,1370.61,1356.48,Included in per diem,1342.35,"$3,950 per Case",1342.35,1342.35," 1,384.74 ",1271.7
45014054,EAP,CPT® 25259,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Manipulate Wrist W/anesthes Cdm,1,1518," 1,442.10 ",1487.64," 1,442.10 "," 1,472.46 "," 1,442.10 ",Current Medicare Rates,1472.46,1457.28,Included in per diem,1442.1,"$3,950 per Case",1442.1,1442.1," 1,487.64 ",1366.2
45010010,EAP,CPT® 64999,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Nerve Block Inj Facial Cdm,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,Included in per diem,427.5,"$3,950 per Case",427.5,427.5, 441.00 ,405
45010465,EAP,CPT® 64455,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,HC ED NERVE BLOCK INJ PLANTAR DIGIT CDM,1,131, 124.45 ,128.38, 124.45 , 127.07 , 124.45 ,Current Medicare Rates,127.07,125.76,Included in per diem,124.45,"$3,950 per Case",124.45,124.45, 128.38 ,117.9
45010459,EAP,CPT® 64400,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Nerve Block Inj Trigeminal Cdm,1,381, 361.95 ,373.38, 361.95 , 369.57 , 361.95 ,Current Medicare Rates,369.57,365.76,Included in per diem,361.95,"$3,950 per Case",361.95,361.95, 373.38 ,342.9
45010849,EAP,CPT® 26765,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Open Tx Distal Phalangeal Fracture Finger/thumb Ea -percutaneous Tx Cdm,1,1440," 1,368.00 ",1411.2," 1,368.00 "," 1,396.80 "," 1,368.00 ",Current Medicare Rates,1396.8,1382.4,Included in per diem,1368,"$3,950 per Case",1368,1368," 1,411.20 ",1296
45010231,EAP,CPT® 26785,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Open Tx Finger Dislocation Cdm,1,1344," 1,276.80 ",1317.12," 1,276.80 "," 1,303.68 "," 1,276.80 ",Current Medicare Rates,1303.68,1290.24,Included in per diem,1276.8,"$3,950 per Case",1276.8,1276.8," 1,317.12 ",1209.6
45014055,EAP,CPT® 21406,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Opn Tx Orbit Fx W/o Implant Cdm,1,5671," 5,387.45 ",5557.58," 5,387.45 "," 5,500.87 "," 5,387.45 ",Current Medicare Rates,5500.87,5444.16,Included in per diem,5387.45,"$3,950 per Case",5387.45,5387.45," 5,557.58 ",5103.9
45013145,EAP,CPT® 29700,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remov Bival Gaun Boot/body Cast Cdm,1,165, 156.75 ,161.7, 156.75 , 160.05 , 156.75 ,Current Medicare Rates,160.05,158.4,Included in per diem,156.75,"$3,950 per Case",156.75,156.75, 161.70 ,148.5
45010606,EAP,CPT® 24200,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Arm Foreign Body Cdm,1,624, 592.80 ,611.52, 592.80 , 605.28 , 592.80 ,Current Medicare Rates,605.28,599.04,Included in per diem,592.8,"$3,950 per Case",592.8,592.8, 611.52 ,561.6
45013029,EAP,CPT® 28190,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Foot Foreign Body Cdm,1,811, 770.45 ,794.78, 770.45 , 786.67 , 770.45 ,Current Medicare Rates,786.67,778.56,Included in per diem,770.45,"$3,950 per Case",770.45,770.45, 794.78 ,729.9
45013032,EAP,CPT® 28192,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Foot Foreign Body Deep Cdm,1,1395," 1,325.25 ",1367.1," 1,325.25 "," 1,353.15 "," 1,325.25 ",Current Medicare Rates,1353.15,1339.2,Included in per diem,1325.25,"$3,950 per Case",1325.25,1325.25," 1,367.10 ",1255.5
45010535,EAP,CPT® 20525,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Foreign Body Complex Cdm,1,1384," 1,314.80 ",1356.32," 1,314.80 "," 1,342.48 "," 1,314.80 ",Current Medicare Rates,1342.48,1328.64,Included in per diem,1314.8,"$3,950 per Case",1314.8,1314.8," 1,356.32 ",1245.6
45010534,EAP,CPT® 20520,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Removal Of Foreign Body Musc, Simp Cdm",1,605, 574.75 ,592.9, 574.75 , 586.85 , 574.75 ,Current Medicare Rates,586.85,580.8,Included in per diem,574.75,"$3,950 per Case",574.75,574.75, 592.90 ,544.5
45010413,EAP,CPT® 46320,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Hemorrhoid Clot Cdm,1,510, 484.50 ,499.8, 484.50 , 494.70 , 484.50 ,Current Medicare Rates,494.7,489.6,Included in per diem,484.5,"$3,950 per Case",484.5,484.5, 499.80 ,459
45010351,EAP,CPT® 11750,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Nail Bed Cdm,1,750, 712.50 ,735, 712.50 , 727.50 , 712.50 ,Current Medicare Rates,727.5,720,Included in per diem,712.5,"$3,950 per Case",712.5,712.5, 735.00 ,675
45010348,EAP,CPT® 11730,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Nail Plate Cdm,1,238, 226.10 ,233.24, 226.10 , 230.86 , 226.10 ,Current Medicare Rates,230.86,228.48,Included in per diem,226.1,"$3,950 per Case",226.1,226.1, 233.24 ,214.2
45010331,EAP,CPT® 11200,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Removal Of Skin Tags Cdm,1,190, 180.50 ,186.2, 180.50 , 184.30 , 180.50 ,Current Medicare Rates,184.3,182.4,Included in per diem,180.5,"$3,950 per Case",180.5,180.5, 186.20 ,171
45014056,EAP,CPT® 69145,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Ear Canal Lesion(s) Cdm,1,940, 893.00 ,921.2, 893.00 , 911.80 , 893.00 ,Current Medicare Rates,911.8,902.4,Included in per diem,893,"$3,950 per Case",893,893, 921.20 ,846
45010484,EAP,CPT® 67938,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Eyelid Foreign Body Cdm,1,897, 852.15 ,879.06, 852.15 , 870.09 , 852.15 ,Current Medicare Rates,870.09,861.12,Included in per diem,852.15,"$3,950 per Case",852.15,852.15, 879.06 ,807.3
45010314,EAP,CPT® 10121,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Foreign Body Complicated Cdm,1,689, 654.55 ,675.22, 654.55 , 668.33 , 654.55 ,Current Medicare Rates,668.33,661.44,Included in per diem,654.55,"$3,950 per Case",654.55,654.55, 675.22 ,620.1
45010662,EAP,CPT® 65235,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Foreign Body From Eye Cdm,1,2451," 2,328.45 ",2401.98," 2,328.45 "," 2,377.47 "," 2,328.45 ",Current Medicare Rates,2377.47,2352.96,Included in per diem,2328.45,"$3,950 per Case",2328.45,2328.45," 2,401.98 ",2205.9
45013170,EAP,CPT® 65222,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Foreign Body From Eye Corneal W/ Slit Lamp Cdm,1,297, 282.15 ,291.06, 282.15 , 288.09 , 282.15 ,Current Medicare Rates,288.09,285.12,Included in per diem,282.15,"$3,950 per Case",282.15,282.15, 291.06 ,267.3
45010471,EAP,CPT® 65220,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Foreign Body From Eye Corneal W/o Slit Lamp Cdm,1,299, 284.05 ,293.02, 284.05 , 290.03 , 284.05 ,Current Medicare Rates,290.03,287.04,Included in per diem,284.05,"$3,950 per Case",284.05,284.05, 293.02 ,269.1
45010469,EAP,CPT® 65210,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Foreign Body From Eye Embedded Cdm,1,344, 326.80 ,337.12, 326.80 , 333.68 , 326.80 ,Current Medicare Rates,333.68,330.24,Included in per diem,326.8,"$3,950 per Case",326.8,326.8, 337.12 ,309.6
45010467,EAP,CPT® 65205,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Foreign Body From Eye Superficial Cdm,1,277, 263.15 ,271.46, 263.15 , 268.69 , 263.15 ,Current Medicare Rates,268.69,265.92,Included in per diem,263.15,"$3,950 per Case",263.15,263.15, 271.46 ,249.3
45010313,EAP,CPT® 10120,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Foreign Body Simple Cdm,1,331, 314.45 ,324.38, 314.45 , 321.07 , 314.45 ,Current Medicare Rates,321.07,317.76,Included in per diem,314.45,"$3,950 per Case",314.45,314.45, 324.38 ,297.9
45010455,EAP,CPT® 58301,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Intrauterine Device Cdm,1,520, 494.00 ,509.6, 494.00 , 504.40 , 494.00 ,Current Medicare Rates,504.4,499.2,Included in per diem,494,"$3,950 per Case",494,494, 509.60 ,468
45010025,EAP,CPT® 30300,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Nasal Foreign Body Cdm,1,476, 452.20 ,466.48, 452.20 , 461.72 , 452.20 ,Current Medicare Rates,461.72,456.96,Included in per diem,452.2,"$3,950 per Case",452.2,452.2, 466.48 ,428.4
45013147,EAP,CPT® 29705,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Or Bivalve Cast-arm Or Leg Cdm,1,224, 212.80 ,219.52, 212.80 , 217.28 , 212.80 ,Current Medicare Rates,217.28,215.04,Included in per diem,212.8,"$3,950 per Case",212.8,212.8, 219.52 ,201.6
45013234,EAP,CPT® 42809,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Pharynx Foreign Body Cdm,1,588, 558.60 ,576.24, 558.60 , 570.36 , 558.60 ,Current Medicare Rates,570.36,564.48,Included in per diem,558.6,"$3,950 per Case",558.6,558.6, 576.24 ,529.2
45010546,EAP,CPT® 23330,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Remove Shoulder Foreign Body Cdm,1,576, 547.20 ,564.48, 547.20 , 558.72 , 547.20 ,Current Medicare Rates,558.72,552.96,Included in per diem,547.2,"$3,950 per Case",547.2,547.2, 564.48 ,518.4
45010872,EAP,CPT® 26410,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Extensor Tendon Hand W/o Graft Cdm,1,2125," 2,018.75 ",2082.5," 2,018.75 "," 2,061.25 "," 2,018.75 ",Current Medicare Rates,2061.25,2040,Included in per diem,2018.75,"$3,950 per Case",2018.75,2018.75," 2,082.50 ",1912.5
45010636,EAP,CPT® 26350,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Finger/hand Tendon Cdm,1,2023," 1,921.85 ",1982.54," 1,921.85 "," 1,962.31 "," 1,921.85 ",Current Medicare Rates,1962.31,1942.08,Included in per diem,1921.85,"$3,950 per Case",1921.85,1921.85," 1,982.54 ",1820.7
45013214,EAP,CPT® 40650,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Lip, Full Thickness Vermilion Only Cdm",1,350, 332.50 ,343, 332.50 , 339.50 , 332.50 ,Current Medicare Rates,339.5,336,Included in per diem,332.5,"$3,950 per Case",332.5,332.5, 343.00 ,315
45013220,EAP,CPT® 40830,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Mouth Laceration <2.5cm Cdm,1,510, 484.50 ,499.8, 484.50 , 494.70 , 484.50 ,Current Medicare Rates,494.7,489.6,Included in per diem,484.5,"$3,950 per Case",484.5,484.5, 499.80 ,459
45013150,EAP,CPT® 29720,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Of Body Cast Cdm,1,264, 250.80 ,258.72, 250.80 , 256.08 , 250.80 ,Current Medicare Rates,256.08,253.44,Included in per diem,250.8,"$3,950 per Case",250.8,250.8, 258.72 ,237.6
45010876,EAP,CPT® 26418,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Of Extensor Tendon Finger W/o Graft Cdm,1,2081," 1,976.95 ",2039.38," 1,976.95 "," 2,018.57 "," 1,976.95 ",Current Medicare Rates,2018.57,1997.76,Included in per diem,1976.95,"$3,950 per Case",1976.95,1976.95," 2,039.38 ",1872.9
45010474,EAP,CPT® 65270,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Of Eye Wound Cdm,1,778, 739.10 ,762.44, 739.10 , 754.66 , 739.10 ,Current Medicare Rates,754.66,746.88,Included in per diem,739.1,"$3,950 per Case",739.1,739.1, 762.44 ,700.2
45013226,EAP,CPT® 41252,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"HC ED REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM OR COMPLE CDM",1,1151," 1,093.45 ",1127.98," 1,093.45 "," 1,116.47 "," 1,093.45 ",Current Medicare Rates,1116.47,1104.96,Included in per diem,1093.45,"$3,950 per Case",1093.45,1093.45," 1,127.98 ",1035.9
45010353,EAP,CPT® 11760,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Of Nail Bed Cdm,1,720, 684.00 ,705.6, 684.00 , 698.40 , 684.00 ,Current Medicare Rates,698.4,691.2,Included in per diem,684,"$3,950 per Case",684,684, 705.60 ,648
45010445,EAP,CPT® 57200,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"HC ED REPAIR OF VAGINA, SUTURE CDM",1,1151," 1,093.45 ",1127.98," 1,093.45 "," 1,116.47 "," 1,093.45 ",Current Medicare Rates,1116.47,1104.96,Included in per diem,1093.45,"$3,950 per Case",1093.45,1093.45," 1,127.98 ",1035.9
45010504,EAP,CPT® 13151,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Of Wound Or Lesion 1.1 To 2.5cm Cmplx Eyld Ns Ers Lip Cdm,1,1320," 1,254.00 ",1293.6," 1,254.00 "," 1,280.40 "," 1,254.00 ",Current Medicare Rates,1280.4,1267.2,Included in per diem,1254,"$3,950 per Case",1254,1254," 1,293.60 ",1188
45010399,EAP,CPT® 13131,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Of Wound Or Lesion 1.1 To 2.5cm Cmplx, Frhd Cks Shn Mth Nk Ax Cdm",1,1036, 984.20 ,1015.28, 984.20 ," 1,004.92 ", 984.20 ,Current Medicare Rates,1004.92,994.56,Included in per diem,984.2,"$3,950 per Case",984.2,984.2," 1,015.28 ",932.4
45010395,EAP,CPT® 13120,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Of Wound Or Lesion 1.1 To 2.5cm Complex, Sclp Arm Leg Cdm",1,823, 781.85 ,806.54, 781.85 , 798.31 , 781.85 ,Current Medicare Rates,798.31,790.08,Included in per diem,781.85,"$3,950 per Case",781.85,781.85, 806.54 ,740.7
45010392,EAP,CPT® 13100,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Of Wound Or Lesion 1.1 To 2.5cm Complex, Trunk Cdm",1,702, 666.90 ,687.96, 666.90 , 680.94 , 666.90 ,Current Medicare Rates,680.94,673.92,Included in per diem,666.9,"$3,950 per Case",666.9,666.9, 687.96 ,631.8
45010505,EAP,CPT® 13152,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Of Wound Or Lesion 2.6 To 7.5cm Cmplx Eyld Ns Ers Lip Cdm,1,2286," 2,171.70 ",2240.28," 2,171.70 "," 2,217.42 "," 2,171.70 ",Current Medicare Rates,2217.42,2194.56,Included in per diem,2171.7,"$3,950 per Case",2171.7,2171.7," 2,240.28 ",2057.4
45010501,EAP,CPT® 13132,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Of Wound Or Lesion 2.6 To 7.5cm Cmplx, Frhd Cks Shn Mth Nk Ax Cdm",1,1821," 1,729.95 ",1784.58," 1,729.95 "," 1,766.37 "," 1,729.95 ",Current Medicare Rates,1766.37,1748.16,Included in per diem,1729.95,"$3,950 per Case",1729.95,1729.95," 1,784.58 ",1638.9
45010396,EAP,CPT® 13121,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Of Wound Or Lesion 2.6 To 7.5cm Complex, Sclp Arm Leg Cdm",1,1343," 1,275.85 ",1316.14," 1,275.85 "," 1,302.71 "," 1,275.85 ",Current Medicare Rates,1302.71,1289.28,Included in per diem,1275.85,"$3,950 per Case",1275.85,1275.85," 1,316.14 ",1208.7
45010393,EAP,CPT® 13101,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Of Wound Or Lesion 2.6 To 7.5cm Complex, Trunk Cdm",1,966, 917.70 ,946.68, 917.70 , 937.02 , 917.70 ,Current Medicare Rates,937.02,927.36,Included in per diem,917.7,"$3,950 per Case",917.7,917.7, 946.68 ,869.4
45010361,EAP,CPT® 12011,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s) <2.5 Face Ers Eyld Nse Lps Muc Cdm,1,417, 396.15 ,408.66, 396.15 , 404.49 , 396.15 ,Current Medicare Rates,404.49,400.32,Included in per diem,396.15,"$3,950 per Case",396.15,396.15, 408.66 ,375.3
45010365,EAP,CPT® 12016,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,HC ED REPAIR SUPERFICIAL WOUND(S) 12.6 TO 20.0CM FACE ERS EYLD NSE LPS MUC CDM,1,987, 937.65 ,967.26, 937.65 , 957.39 , 937.65 ,Current Medicare Rates,957.39,947.52,Included in per diem,937.65,"$3,950 per Case",937.65,937.65, 967.26 ,888.3
45010362,EAP,CPT® 12013,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s) 2.6 To 5.0cm Face Ers Eyld Nse Lps Muc Cdm,1,525, 498.75 ,514.5, 498.75 , 509.25 , 498.75 ,Current Medicare Rates,509.25,504,Included in per diem,498.75,"$3,950 per Case",498.75,498.75, 514.50 ,472.5
45010356,EAP,CPT® 12002,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s) 2.6 To 7.5cm Slp Nk Ax Exgen Trnk Extr Hn Cdm,1,439, 417.05 ,430.22, 417.05 , 425.83 , 417.05 ,Current Medicare Rates,425.83,421.44,Included in per diem,417.05,"$3,950 per Case",417.05,417.05, 430.22 ,395.1
45010359,EAP,CPT® 12006,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s) 20.1-30.0cm Slp Nk Ax Exgen Trnk Extr Hnd Cdm,1,830, 788.50 ,813.4, 788.50 , 805.10 , 788.50 ,Current Medicare Rates,805.1,796.8,Included in per diem,788.5,"$3,950 per Case",788.5,788.5, 813.40 ,747
45010363,EAP,CPT® 12014,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s) 5.1 To 7.5cm Face Ers Eyld Nse Lps Muc Cdm,1,644, 611.80 ,631.12, 611.80 , 624.68 , 611.80 ,Current Medicare Rates,624.68,618.24,Included in per diem,611.8,"$3,950 per Case",611.8,611.8, 631.12 ,579.6
45010364,EAP,CPT® 12015,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s) 7.6 To 12.5cm Face Ers Eyld Nse Lps Muc Cdm,1,775, 736.25 ,759.5, 736.25 , 751.75 , 736.25 ,Current Medicare Rates,751.75,744,Included in per diem,736.25,"$3,950 per Case",736.25,736.25, 759.50 ,697.5
45010355,EAP,CPT® 12001,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s)< 2.5cm Slp Nk Ax Exgen Trnk Extr Hnd Ft Cdm,1,361, 342.95 ,353.78, 342.95 , 350.17 , 342.95 ,Current Medicare Rates,350.17,346.56,Included in per diem,342.95,"$3,950 per Case",342.95,342.95, 353.78 ,324.9
45010358,EAP,CPT® 12005,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s)12.6 To 20.0cm Slp Nk Ax Exgen Trnk Extr H Cdm,1,708, 672.60 ,693.84, 672.60 , 686.76 , 672.60 ,Current Medicare Rates,686.76,679.68,Included in per diem,672.6,"$3,950 per Case",672.6,672.6, 693.84 ,637.2
45010357,EAP,CPT® 12004,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Repair Superficial Wound(s)7.6 To 12.5cm Slp Nk Ax Exgen Trnk Extr Hn Cdm,1,525, 498.75 ,514.5, 498.75 , 509.25 , 498.75 ,Current Medicare Rates,509.25,504,Included in per diem,498.75,"$3,950 per Case",498.75,498.75, 514.50 ,472.5
45013224,EAP,CPT® 41250,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,"Hc Ed Repair Tongue Laceration <2.6cm, Floor Of Mouth And/or Anterior Two-t Cdm",1,553, 525.35 ,541.94, 525.35 , 536.41 , 525.35 ,Current Medicare Rates,536.41,530.88,Included in per diem,525.35,"$3,950 per Case",525.35,525.35, 541.94 ,497.7
45010675,EAP,CPT® 20822,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Replantation Digit Complete Cdm,1,2192," 2,082.40 ",2148.16," 2,082.40 "," 2,126.24 "," 2,082.40 ",Current Medicare Rates,2126.24,2104.32,Included in per diem,2082.4,"$3,950 per Case",2082.4,2082.4," 2,148.16 ",1972.8
45010556,EAP,CPT® 21480,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Reset Dislocated Jaw Uncomplicated Cdm,1,504, 478.80 ,493.92, 478.80 , 488.88 , 478.80 ,Current Medicare Rates,488.88,483.84,Included in per diem,478.8,"$3,950 per Case",478.8,478.8, 493.92 ,453.6
45010770,EAP,CPT® 25260,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Rpr Tdn/musc Flxr F/arm&/wrst Prim 1 Ea Tdn/mu Cdm,1,2797," 2,657.15 ",2741.06," 2,657.15 "," 2,713.09 "," 2,657.15 ",Current Medicare Rates,2713.09,2685.12,Included in per diem,2657.15,"$3,950 per Case",2657.15,2657.15," 2,741.06 ",2517.3
45010130,EAP,CPT® 99284,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Sexual Assault Exam Cdm,1,762, 723.90 ,746.76, 723.90 , 739.14 , 723.90 ,Current Medicare Rates,739.14,731.52,Included in per diem,723.9,"$3,950 per Case",723.9,723.9, 746.76 ,685.8
45013099,EAP,CPT® 29075,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Short Arm Cast Application Cdm,1,289, 274.55 ,283.22, 274.55 , 280.33 , 274.55 ,Current Medicare Rates,280.33,277.44,Included in per diem,274.55,"$3,950 per Case",274.55,274.55, 283.22 ,260.1
45013110,EAP,CPT® 29125,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Short Arm Splint Application Cdm,1,229, 217.55 ,224.42, 217.55 , 222.13 , 217.55 ,Current Medicare Rates,222.13,219.84,Included in per diem,217.55,"$3,950 per Case",217.55,217.55, 224.42 ,206.1
45013123,EAP,CPT® 29405,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Short Leg Cast Application Cdm,1,441, 418.95 ,432.18, 418.95 , 427.77 , 418.95 ,Current Medicare Rates,427.77,423.36,Included in per diem,418.95,"$3,950 per Case",418.95,418.95, 432.18 ,396.9
45013130,EAP,CPT® 29515,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Short Leg Splint Application Cdm,1,277, 263.15 ,271.46, 263.15 , 268.69 , 263.15 ,Current Medicare Rates,268.69,265.92,Included in per diem,263.15,"$3,950 per Case",263.15,263.15, 271.46 ,249.3
45010512,EAP,CPT® 15050,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Skin Pinch Graft 2 Cm Diameter Cdm,1,1261," 1,197.95 ",1235.78," 1,197.95 "," 1,223.17 "," 1,197.95 ",Current Medicare Rates,1223.17,1210.56,Included in per diem,1197.95,"$3,950 per Case",1197.95,1197.95," 1,235.78 ",1134.9
45013137,EAP,CPT® 29540,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Strapping Of Ankle And/or Ft Cdm,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,"$3,950 per Case",114,114, 117.60 ,108
45013139,EAP,CPT® 29550,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Strapping Of Toes Cdm,1,109, 103.55 ,106.82, 103.55 , 105.73 , 103.55 ,Current Medicare Rates,105.73,104.64,Included in per diem,103.55,"$3,950 per Case",103.55,103.55, 106.82 ,98.1
45010536,EAP,CPT® 20526,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Ther Injection Carp Tunnel Cdm,1,328, 311.60 ,321.44, 311.60 , 318.16 , 311.60 ,Current Medicare Rates,318.16,314.88,Included in per diem,311.6,"$3,950 per Case",311.6,311.6, 321.44 ,295.2
45013069,EAP,CPT® 28495,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Big Toe Fracture W/manipulation Cdm,1,534, 507.30 ,523.32, 507.30 , 517.98 , 507.30 ,Current Medicare Rates,517.98,512.64,Included in per diem,507.3,"$3,950 per Case",507.3,507.3, 523.32 ,480.6
45010820,EAP,CPT® 25630,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Carpal Bone Fracture W/o Manip Each Bone Cdm,1,994, 944.30 ,974.12, 944.30 , 964.18 , 944.30 ,Current Medicare Rates,964.18,954.24,Included in per diem,944.3,"$3,950 per Case",944.3,944.3, 974.12 ,894.6
45010909,EAP,CPT® 26641,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Carpometacarpal Dislocation W/manip Cdm,1,1063," 1,009.85 ",1041.74," 1,009.85 "," 1,031.11 "," 1,009.85 ",Current Medicare Rates,1031.11,1020.48,Included in per diem,1009.85,"$3,950 per Case",1009.85,1009.85," 1,041.74 ",956.7
45010579,EAP,CPT® 23545,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Clavicle Dislocation Ac Jt Dislo W/man Cdm,1,1010, 959.50 ,989.8, 959.50 , 979.70 , 959.50 ,Current Medicare Rates,979.7,969.6,Included in per diem,959.5,"$3,950 per Case",959.5,959.5, 989.80 ,909
45010569,EAP,CPT® 23505,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Clavicle Fracture W/manip Cdm,1,1181," 1,121.95 ",1157.38," 1,121.95 "," 1,145.57 "," 1,121.95 ",Current Medicare Rates,1145.57,1133.76,Included in per diem,1121.95,"$3,950 per Case",1121.95,1121.95," 1,157.38 ",1062.9
45010566,EAP,CPT® 23500,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Clavicle Fracture W/o Manip Cdm,1,737, 700.15 ,722.26, 700.15 , 714.89 , 700.15 ,Current Medicare Rates,714.89,707.52,Included in per diem,700.15,"$3,950 per Case",700.15,700.15, 722.26 ,663.3
45010808,EAP,CPT® 25605,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Distal Radial Fracture Radius/ulna W/manip Cdm,1,1945," 1,847.75 ",1906.1," 1,847.75 "," 1,886.65 "," 1,847.75 ",Current Medicare Rates,1886.65,1867.2,Included in per diem,1847.75,"$3,950 per Case",1847.75,1847.75," 1,906.10 ",1750.5
45010804,EAP,CPT® 25600,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Distal Radial Fracture Radius/ulna W/o Manip Cdm,1,1114," 1,058.30 ",1091.72," 1,058.30 "," 1,080.58 "," 1,058.30 ",Current Medicare Rates,1080.58,1069.44,Included in per diem,1058.3,"$3,950 per Case",1058.3,1058.3," 1,091.72 ",1002.6
45010741,EAP,CPT® 24605,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Elbow Dislocation W/anesth Cdm,1,1367," 1,298.65 ",1339.66," 1,298.65 "," 1,325.99 "," 1,298.65 ",Current Medicare Rates,1325.99,1312.32,Included in per diem,1298.65,"$3,950 per Case",1298.65,1298.65," 1,339.66 ",1230.3
45010738,EAP,CPT® 24600,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Elbow Dislocation W/o Anesth Cdm,1,1237," 1,175.15 ",1212.26," 1,175.15 "," 1,199.89 "," 1,175.15 ",Current Medicare Rates,1199.89,1187.52,Included in per diem,1175.15,"$3,950 per Case",1175.15,1175.15," 1,212.26 ",1113.3
45010798,EAP,CPT® 25560,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Fracture Of Radius And Ulna W/o Manip Cdm,1,970, 921.50 ,950.6, 921.50 , 940.90 , 921.50 ,Current Medicare Rates,940.9,931.2,Included in per diem,921.5,"$3,950 per Case",921.5,921.5, 950.60 ,873
45010782,EAP,CPT® 25505,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Fracture Of Radius W/manipulation Cdm,1,1786," 1,696.70 ",1750.28," 1,696.70 "," 1,732.42 "," 1,696.70 ",Current Medicare Rates,1732.42,1714.56,Included in per diem,1696.7,"$3,950 per Case",1696.7,1696.7," 1,750.28 ",1607.4
45010778,EAP,CPT® 25500,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Fracture Of Radius W/o Manipulation Cdm,1,932, 885.40 ,913.36, 885.40 , 904.04 , 885.40 ,Current Medicare Rates,904.04,894.72,Included in per diem,885.4,"$3,950 per Case",885.4,885.4, 913.36 ,838.8
45010790,EAP,CPT® 25530,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Fracture Of Ulna Cdm,1,944, 896.80 ,925.12, 896.80 , 915.68 , 896.80 ,Current Medicare Rates,915.68,906.24,Included in per diem,896.8,"$3,950 per Case",896.8,896.8, 925.12 ,849.6
45010801,EAP,CPT® 25565,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Fracture Radius & Ulna W/manipulation Cdm,1,2055," 1,952.25 ",2013.9," 1,952.25 "," 1,993.35 "," 1,952.25 ",Current Medicare Rates,1993.35,1972.8,Included in per diem,1952.25,"$3,950 per Case",1952.25,1952.25," 2,013.90 ",1849.5
45010622,EAP,CPT® 27257,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Hip Dislocation W/anesth Cdm,1,1825," 1,733.75 ",1788.5," 1,733.75 "," 1,770.25 "," 1,733.75 ",Current Medicare Rates,1770.25,1752,Included in per diem,1733.75,"$3,950 per Case",1733.75,1733.75," 1,788.50 ",1642.5
45010722,EAP,CPT® 24560,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Humerus Epicond Fracture Cdm,1,1065," 1,011.75 ",1043.7," 1,011.75 "," 1,033.05 "," 1,011.75 ",Current Medicare Rates,1033.05,1022.4,Included in per diem,1011.75,"$3,950 per Case",1011.75,1011.75," 1,043.70 ",958.5
45010713,EAP,CPT® 24530,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Humerus Fracture Cdm,1,936, 889.20 ,917.28, 889.20 , 907.92 , 889.20 ,Current Medicare Rates,907.92,898.56,Included in per diem,889.2,"$3,950 per Case",889.2,889.2, 917.28 ,842.4
45010588,EAP,CPT® 23605,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Humerus Fracture W/manip Cdm,1,512, 486.40 ,501.76, 486.40 , 496.64 , 486.40 ,Current Medicare Rates,496.64,491.52,Included in per diem,486.4,"$3,950 per Case",486.4,486.4, 501.76 ,460.8
45010585,EAP,CPT® 23600,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Humerus Fracture W/o Manip Cdm,1,1132," 1,075.40 ",1109.36," 1,075.40 "," 1,098.04 "," 1,075.40 ",Current Medicare Rates,1098.04,1086.72,Included in per diem,1075.4,"$3,950 per Case",1075.4,1075.4," 1,109.36 ",1018.8
45010709,EAP,CPT® 24505,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Humerus Fx W/manip Cdm,1,2498," 2,373.10 ",2448.04," 2,373.10 "," 2,423.06 "," 2,373.10 ",Current Medicare Rates,2423.06,2398.08,Included in per diem,2373.1,"$3,950 per Case",2373.1,2373.1," 2,448.04 ",2248.2
45010705,EAP,CPT® 24500,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Humerus Fx W/o Manip Cdm,1,1242," 1,179.90 ",1217.16," 1,179.90 "," 1,204.74 "," 1,179.90 ",Current Medicare Rates,1204.74,1192.32,Included in per diem,1179.9,"$3,950 per Case",1179.9,1179.9," 1,217.16 ",1117.8
45010159,EAP,CPT® 27550,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Knee Dislocation Cdm,1,1555," 1,477.25 ",1523.9," 1,477.25 "," 1,508.35 "," 1,477.25 ",Current Medicare Rates,1508.35,1492.8,Included in per diem,1477.25,"$3,950 per Case",1477.25,1477.25," 1,523.90 ",1399.5
45010904,EAP,CPT® 26605,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Metacarpal Fracture Single W/manipulation Cdm,1,988, 938.60 ,968.24, 938.60 , 958.36 , 938.60 ,Current Medicare Rates,958.36,948.48,Included in per diem,938.6,"$3,950 per Case",938.6,938.6, 968.24 ,889.2
45010900,EAP,CPT® 26600,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Metacarpal Fracture Single W/o Manip Cdm,1,785, 745.75 ,769.3, 745.75 , 761.45 , 745.75 ,Current Medicare Rates,761.45,753.6,Included in per diem,745.75,"$3,950 per Case",745.75,745.75, 769.30 ,706.5
45013063,EAP,CPT® 28470,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Metatarsal Fracture W/o Manipulation Cdm,1,825, 783.75 ,808.5, 783.75 , 800.25 , 783.75 ,Current Medicare Rates,800.25,792,Included in per diem,783.75,"$3,950 per Case",783.75,783.75, 808.50 ,742.5
45010752,EAP,CPT® 24650,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Radius Fracture Cdm,1,931, 884.45 ,912.38, 884.45 , 903.07 , 884.45 ,Current Medicare Rates,903.07,893.76,Included in per diem,884.45,"$3,950 per Case",884.45,884.45, 912.38 ,837.9
45010596,EAP,CPT® 23655,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Shoulder Dislocation W/manip & Annes Cdm,1,"1,482.00"," 1,407.90 ",1452.36," 1,407.90 "," 1,437.54 "," 1,407.90 ",Current Medicare Rates,1437.54,1422.72,Included in per diem,1407.9,"$3,950 per Case",1407.9,1407.9," 1,452.36 ",1333.8
45010594,EAP,CPT® 23650,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Shoulder Dislocation W/manip Cdm,1,1075," 1,021.25 ",1053.5," 1,021.25 "," 1,042.75 "," 1,021.25 ",Current Medicare Rates,1042.75,1032,Included in per diem,1021.25,"$3,950 per Case",1021.25,1021.25," 1,053.50 ",967.5
45010562,EAP,CPT® 22310,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Spine Fracture Cdm,1,2112," 2,006.40 ",2069.76," 2,006.40 "," 2,048.64 "," 2,006.40 ",Current Medicare Rates,2048.64,2027.52,Included in per diem,2006.4,"$3,950 per Case",2006.4,2006.4," 2,069.76 ",1900.8
45010560,EAP,CPT® 21820,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Sternum Fracture Cdm,1,744, 706.80 ,729.12, 706.80 , 721.68 , 706.80 ,Current Medicare Rates,721.68,714.24,Included in per diem,706.8,"$3,950 per Case",706.8,706.8, 729.12 ,669.6
45010760,EAP,CPT® 24670,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Ulnar Fracture Cdm,1,921, 874.95 ,902.58, 874.95 , 893.37 , 874.95 ,Current Medicare Rates,893.37,884.16,Included in per diem,874.95,"$3,950 per Case",874.95,874.95, 902.58 ,828.9
45010828,EAP,CPT® 25650,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Ulnar Styloid Fracture Cdm,1,1174," 1,115.30 ",1150.52," 1,115.30 "," 1,138.78 "," 1,115.30 ",Current Medicare Rates,1138.78,1127.04,Included in per diem,1115.3,"$3,950 per Case",1115.3,1115.3," 1,150.52 ",1056.6
45010812,EAP,CPT® 25622,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Wrist Bone Fracture Cdm,1,983, 933.85 ,963.34, 933.85 , 953.51 , 933.85 ,Current Medicare Rates,953.51,943.68,Included in per diem,933.85,"$3,950 per Case",933.85,933.85, 963.34 ,884.7
45010832,EAP,CPT® 25660,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treat Wrist Dislocation W/manipulation Cdm,1,1240," 1,178.00 ",1215.2," 1,178.00 "," 1,202.80 "," 1,178.00 ",Current Medicare Rates,1202.8,1190.4,Included in per diem,1178,"$3,950 per Case",1178,1178," 1,215.20 ",1116
45013045,EAP,CPT® 28400,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treatment Of Heel Fracture W/o Manipulation Cdm,1,"1,046.00", 993.70 ,1025.08, 993.70 ," 1,014.62 ", 993.70 ,Current Medicare Rates,1014.62,1004.16,Included in per diem,993.7,"$3,950 per Case",993.7,993.7," 1,025.08 ",941.4
45010612,EAP,CPT® 21315,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treatment Of Nose Fracture W/o Stabilization Cdm,1,693, 658.35 ,679.14, 658.35 , 672.21 , 658.35 ,Current Medicare Rates,672.21,665.28,Included in per diem,658.35,"$3,950 per Case",658.35,658.35, 679.14 ,623.7
45013051,EAP,CPT® 28430,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treatment Of Talus Fracture W/o Manip Cdm,1,995.00, 945.25 ,975.1, 945.25 , 965.15 , 945.25 ,Current Medicare Rates,965.15,955.2,Included in per diem,945.25,"$3,950 per Case",945.25,945.25, 975.10 ,895.5
45013075,EAP,CPT® 28510,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treatment Of Toe Fracture Phalanx Cdm,1,455, 432.25 ,445.9, 432.25 , 441.35 , 432.25 ,Current Medicare Rates,441.35,436.8,Included in per diem,432.25,"$3,950 per Case",432.25,432.25, 445.90 ,409.5
45013076,EAP,CPT® 28515,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Treatment Of Toe Fracture Phalanx W/manip Cdm,1,443.00, 420.85 ,434.14, 420.85 , 429.71 , 420.85 ,Current Medicare Rates,429.71,425.28,Included in per diem,420.85,"$3,950 per Case",420.85,420.85, 434.14 ,398.7
45010915,EAP,CPT® 26645,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Tx Carpometacarpal Fracture/dislocation W/manip Cdm,1,1208," 1,147.60 ",1183.84," 1,147.60 "," 1,171.76 "," 1,147.60 ",Current Medicare Rates,1171.76,1159.68,Included in per diem,1147.6,"$3,950 per Case",1147.6,1147.6," 1,183.84 ",1087.2
45010139,EAP,CPT® 27197,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Tx Pelvic Fx W/o Manip Cdm,1,"1,884.00"," 1,789.80 ",1846.32," 1,789.80 "," 1,827.48 "," 1,789.80 ",Current Medicare Rates,1827.48,1808.64,Included in per diem,1789.8,"$3,950 per Case",1789.8,1789.8," 1,846.32 ",1695.6
45010275,EAP,CPT® 27266,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Tx Post Hip Arthroplasty Dislocation W/anesth Cdm,1,"1,534.00"," 1,457.30 ",1503.32," 1,457.30 "," 1,487.98 "," 1,457.30 ",Current Medicare Rates,1487.98,1472.64,Included in per diem,1457.3,"$3,950 per Case",1457.3,1457.3," 1,503.32 ",1380.6
45010271,EAP,CPT® 27265,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Tx Post Hip Arthroplasty Dislocation W/o Anesth Cdm,1,443.00, 420.85 ,434.14, 420.85 , 429.71 , 420.85 ,Current Medicare Rates,429.71,425.28,Included in per diem,420.85,"$3,950 per Case",420.85,420.85, 434.14 ,398.7
45010269,EAP,CPT® 27256,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Tx Spontaneous Hip Dislocation By Abduction W/o Anesth W/o Manip Cdm,1,"1,535.00"," 1,458.25 ",1504.3," 1,458.25 "," 1,488.95 "," 1,458.25 ",Current Medicare Rates,1488.95,1473.6,Included in per diem,1458.25,"$3,950 per Case",1458.25,1458.25," 1,504.30 ",1381.5
45010257,EAP,CPT® 27230,,0450 - EMERGENCY ROOM - GENERAL CLASSIFICATION,Hc Ed Tx Thigh Fracture Prox End Neck W/o Manip Cdm,1,"1,660.00"," 1,577.00 ",1626.8," 1,577.00 "," 1,610.20 "," 1,577.00 ",Current Medicare Rates,1610.2,1593.6,Included in per diem,1577,"$3,950 per Case",1577,1577," 1,626.80 ",1494
46000001,EAP,94619,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,HC XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG CDM,1,90, 85.50 ,88.2, 85.50 , 87.30 , 85.50 ,Current Medicare Rates,87.3,86.4,Included in per diem,85.5,Included in ER Case rate,85.5,85.5, 88.20 ,81
46010012,EAP,CPT® 94729,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,Hc Diffusing Capacity,1,100.00, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,Included in per diem,95,Included in ER Case rate,95,95, 98.00 ,90
46010011,EAP,CPT® 94617,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,Hc Exercise Tst Brncspsm,1,236.00, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
46010048,EAP,CPT® 94618,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,Hc Pulmonary Stress Testing - Six Minute Walk,1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,Included in per diem,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
41010011,EAP,CPT® 94760,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,Hc Pulse Oximetry Single Determination,1,80.00, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
46010055,EAP,CPT® 94010,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,Hc Spirometry,1,215, 204.25 ,210.7, 204.25 , 208.55 , 204.25 ,Current Medicare Rates,208.55,206.4,Included in per diem,204.25,Included in ER Case rate,204.25,204.25, 210.70 ,193.5
46010063,EAP,CPT® 94060,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,Hc Spirometry Pre Post Bronchodilator,1,447, 424.65 ,438.06, 424.65 , 433.59 , 424.65 ,Current Medicare Rates,433.59,429.12,Included in per diem,424.65,Included in ER Case rate,424.65,424.65, 438.06 ,402.3
46010090,EAP,CPT® 94150,,0460 - PULMONARY FUNCTION - GENERAL CLASSIFICATION,"Hc Vital Capacity, Total (separate Procedure)",1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
47010002,EAP,CPT® 92551,,0470 - AUDIOLOGY - GENERAL CLASSIFICATION,Hc Pure Tone Hearing Test Air,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
47100004,EAP,92651,,0471 - AUDIOLOGY - DIAGNOSTIC,HC AEP HEARING STATUS DETER BROADBAND STIMULI I&R CDM,1,236, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
47100006,EAP,92653,,0471 - AUDIOLOGY - DIAGNOSTIC,HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT CDM,1,236, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
47100007,EAP,92650,,0471 - AUDIOLOGY - DIAGNOSTIC,HC AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS CDM,1,236.00, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
47100005,EAP,92652,,0471 - AUDIOLOGY - DIAGNOSTIC,HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R CDM,1,236.00, 224.20 ,231.28, 224.20 , 228.92 , 224.20 ,Current Medicare Rates,228.92,226.56,Included in per diem,224.2,Included in ER Case rate,224.2,224.2, 231.28 ,212.4
47100003,EAP,92519,,0471 - AUDIOLOGY - DIAGNOSTIC,HC CERVICAL & OCULAR VEMP TESTING W/I&R CDM,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
47100001,EAP,92517,,0471 - AUDIOLOGY - DIAGNOSTIC,HC CERVICAL VEMP TESTING W/I&R CDM,1,192.00, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
47100002,EAP,92518,,0471 - AUDIOLOGY - DIAGNOSTIC,HC OCULAR VEMP TESTING W/I&R CDM,1,192, 182.40 ,188.16, 182.40 , 186.24 , 182.40 ,Current Medicare Rates,186.24,184.32,Included in per diem,182.4,Included in ER Case rate,182.4,182.4, 188.16 ,172.8
47110105,EAP,CPT® 92558,,0471 - AUDIOLOGY - DIAGNOSTIC,Hc Automated Oae Screening,1,216, 205.20 ,211.68, 205.20 , 209.52 , 205.20 ,Current Medicare Rates,209.52,207.36,Included in per diem,205.2,Included in ER Case rate,205.2,205.2, 211.68 ,194.4
47110026,EAP,CPT® 92588,,0471 - AUDIOLOGY - DIAGNOSTIC,Hc Evoked Auditory Test Comp,1,225, 213.75 ,220.5, 213.75 , 218.25 , 213.75 ,Current Medicare Rates,218.25,216,Included in per diem,213.75,Included in ER Case rate,213.75,213.75, 220.50 ,202.5
48010001,EAP,CPT® 92960,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,Hc Cardioversion Elective External,1,947, 899.65 ,928.06, 899.65 , 918.59 , 899.65 ,Current Medicare Rates,918.59,909.12,Included in per diem,899.65,Included in ER Case rate,899.65,899.65, 928.06 ,852.3
48010067,EAP,CPT® 93325,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,Hc Echo Color Doppler,1,505, 479.75 ,494.9, 479.75 , 489.85 , 479.75 ,Current Medicare Rates,489.85,484.8,Included in per diem,479.75,Included in ER Case rate,479.75,479.75, 494.90 ,454.5
48010074,EAP,CPT® 93320,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,Hc Echo Doppler Pulse Contin Comp,1,737.00, 700.15 ,722.26, 700.15 , 714.89 , 700.15 ,Current Medicare Rates,714.89,707.52,Included in per diem,700.15,Included in ER Case rate,700.15,700.15, 722.26 ,663.3
48010075,EAP,CPT® 93350,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,HC ECHO STRESS TEST W/INTERP & REPT,1,1242," 1,179.90 ",1217.16," 1,179.90 "," 1,204.74 "," 1,179.90 ",Current Medicare Rates,1204.74,1192.32,Included in per diem,1179.9,Included in ER Case rate,1179.9,1179.9," 1,217.16 ",1117.8
48010059,EAP,CPT® 93308,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,Hc Echo Tte 2d M-mode Ltd,1,1055," 1,002.25 ",1033.9," 1,002.25 "," 1,023.35 "," 1,002.25 ",Current Medicare Rates,1023.35,1012.8,Included in per diem,1002.25,Included in ER Case rate,1002.25,1002.25," 1,033.90 ",949.5
48010057,EAP,CPT® 93307,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,Hc Echo Tte 2d W/o Color & Dop,1,1068," 1,014.60 ",1046.64," 1,014.60 "," 1,035.96 "," 1,014.60 ",Current Medicare Rates,1035.96,1025.28,Included in per diem,1014.6,Included in ER Case rate,1014.6,1014.6," 1,046.64 ",961.2
48010077,EAP,HCPCS C8929,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,Hc Echo W/wo Contrast Dop Color,1,"3,203.00"," 3,042.85 ",3138.94," 3,042.85 "," 3,106.91 "," 3,042.85 ",Current Medicare Rates,3106.91,3074.88,Included in per diem,3042.85,Included in ER Case rate,3042.85,3042.85," 3,138.94 ",2882.7
48010118,EAP,CPT® 93642,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,Hc Ep Evaluation Of Single/dual Icd,1,28.00, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
48010117,EAP,CPT® 93641,,0480 - CARDIOLOGY - GENERAL CLASSIFICATION,"Hc Eval Icd Leads & Gen, Int/repl",1,28.00, 26.60 ,27.44, 26.60 , 27.16 , 26.60 ,Current Medicare Rates,27.16,26.88,Included in per diem,26.6,Included in ER Case rate,26.6,26.6, 27.44 ,25.2
48210003,EAP,CPT® 93017,,0482 - CARDIOLOGY - STRESS TEST,Hc Cardio Stress Test Tracing Only,1,681, 646.95 ,667.38, 646.95 , 660.57 , 646.95 ,Current Medicare Rates,660.57,653.76,Included in per diem,646.95,Included in ER Case rate,646.95,646.95, 667.38 ,612.9
48210017,EAP,93268,,0482 - CARDIOLOGY - STRESS TEST,HC ECG RECORD/REVIEW,1,666, 632.70 ,652.68, 632.70 , 646.02 , 632.70 ,Current Medicare Rates,646.02,639.36,Included in per diem,632.7,Included in ER Case rate,632.7,632.7, 652.68 ,599.4
48210019,EAP,CPT® 93270,,0482 - CARDIOLOGY - STRESS TEST,"HC HOLTER ATTENDED MONITORING 30 DAY, connection, recording and disconnection",1,316, 300.20 ,309.68, 300.20 , 306.52 , 300.20 ,Current Medicare Rates,306.52,303.36,Included in per diem,300.2,Included in ER Case rate,300.2,300.2, 309.68 ,284.4
48310017,EAP,CPT® 93352,,0483 - CARDIOLOGY - ECHOCARDIOLOGY,Hc Echo Adm Constrast During Stress,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
48310013,EAP,CPT® 93321,,0483 - CARDIOLOGY - ECHOCARDIOLOGY,Hc Echo Doppler Pulse Contin Ltd,1,345, 327.75 ,338.1, 327.75 , 334.65 , 327.75 ,Current Medicare Rates,334.65,331.2,Included in per diem,327.75,Included in ER Case rate,327.75,327.75, 338.10 ,310.5
48310016,EAP,CPT® 93351,,0483 - CARDIOLOGY - ECHOCARDIOLOGY,Hc Echo Stress W/interp Rept & Monitor,1,907, 861.65 ,888.86, 861.65 , 879.79 , 861.65 ,Current Medicare Rates,879.79,870.72,Included in per diem,861.65,Included in ER Case rate,861.65,861.65, 888.86 ,816.3
48310001,EAP,CPT® 93303,,0483 - CARDIOLOGY - ECHOCARDIOLOGY,Hc Echo Tte Congenital Complete,1,1573," 1,494.35 ",1541.54," 1,494.35 "," 1,525.81 "," 1,494.35 ",Current Medicare Rates,1525.81,1510.08,Included in per diem,1494.35,Included in ER Case rate,1494.35,1494.35," 1,541.54 ",1415.7
48310002,EAP,CPT® 93304,,0483 - CARDIOLOGY - ECHOCARDIOLOGY,Hc Echo Tte Congenital Ltd,1,"1,161.00"," 1,102.95 ",1137.78," 1,102.95 "," 1,126.17 "," 1,102.95 ",Current Medicare Rates,1126.17,1114.56,Included in per diem,1102.95,Included in ER Case rate,1102.95,1102.95," 1,137.78 ",1044.9
48310024,EAP,HCPCS C8928,,0483 - CARDIOLOGY - ECHOCARDIOLOGY,Hc Echo W/wo Contrast Stress Test,1,1370," 1,301.50 ",1342.6," 1,301.50 "," 1,328.90 "," 1,301.50 ",Current Medicare Rates,1328.9,1315.2,Included in per diem,1301.5,Included in ER Case rate,1301.5,1301.5," 1,342.60 ",1233
48310003,EAP,CPT® 93306,,0483 - CARDIOLOGY - ECHOCARDIOLOGY,Hc Tte Echo 2d W/color & Dop,1,"2,427.00"," 2,305.65 ",2378.46," 2,305.65 "," 2,354.19 "," 2,305.65 ",Current Medicare Rates,2354.19,2329.92,Included in per diem,2305.65,Included in ER Case rate,2305.65,2305.65," 2,378.46 ",2184.3
51010005,EAP,CPT® 93793,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Anticoag Mgmt Pt Warfarin,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
51010370,EAP,CPT® 41100,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Biopsy Of Tongue,1,522, 495.90 ,511.56, 495.90 , 506.34 , 495.90 ,Current Medicare Rates,506.34,501.12,Included in per diem,495.9,Included in ER Case rate,495.9,495.9, 511.56 ,469.8
51010006,EAP,CPT® 95249,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Continuous Gluc Mntr Pt Prov Eqp,1,137, 130.15 ,134.26, 130.15 , 132.89 , 130.15 ,Current Medicare Rates,132.89,131.52,Included in per diem,130.15,Included in ER Case rate,130.15,130.15, 134.26 ,123.3
45010285,EAP,CPT® 27301,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Ed I&d Deep Absc Bursa/hematoma Thigh/knee Region Cdm,1,1896," 1,801.20 ",1858.08," 1,801.20 "," 1,839.12 "," 1,801.20 ",Current Medicare Rates,1839.12,1820.16,Included in per diem,1801.2,Included in ER Case rate,1801.2,1801.2," 1,858.08 ",1706.4
51010437,EAP,CPT® 11641,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc Face-mm Malig+marg 0.6-1,1,800, 760.00 ,784, 760.00 , 776.00 , 760.00 ,Current Medicare Rates,776,768,Included in per diem,760,Included in ER Case rate,760,760, 784.00 ,720
51010438,EAP,CPT® 11642,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc Face-mm Malig+marg 1.1-2,1,994, 944.30 ,974.12, 944.30 , 964.18 , 944.30 ,Current Medicare Rates,964.18,954.24,Included in per diem,944.3,Included in ER Case rate,944.3,944.3, 974.12 ,894.6
51010344,EAP,CPT® 11646,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc Face-mm Mlg+marg > 4 Cm,1,2011," 1,910.45 ",1970.78," 1,910.45 "," 1,950.67 "," 1,910.45 ",Current Medicare Rates,1950.67,1930.56,Included in per diem,1910.45,Included in ER Case rate,1910.45,1910.45," 1,970.78 ",1809.9
51010433,EAP,CPT® 11621,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc H-f-nk-sp Mlg+marg 0.6-1,1,704.00, 668.80 ,689.92, 668.80 , 682.88 , 668.80 ,Current Medicare Rates,682.88,675.84,Included in per diem,668.8,Included in ER Case rate,668.8,668.8, 689.92 ,633.6
51010421,EAP,CPT® 11406,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc Tr-ext B9+marg > 4.0 Cm,1,908, 862.60 ,889.84, 862.60 , 880.76 , 862.60 ,Current Medicare Rates,880.76,871.68,Included in per diem,862.6,Included in ER Case rate,862.6,862.6, 889.84 ,817.2
51010417,EAP,CPT® 11400,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc Tr-ext B9+marg 0.5 < Cm,1,433.65, 411.97 ,424.98, 411.97 , 420.64 , 411.97 ,Current Medicare Rates,420.64,416.3,Included in per diem,411.97,Included in ER Case rate,411.97,411.97, 424.98 ,390.285
51010418,EAP,CPT® 11402,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc Tr-ext B9+marg 1.1-2 Cm,1,602, 571.90 ,589.96, 571.90 , 583.94 , 571.90 ,Current Medicare Rates,583.94,577.92,Included in per diem,571.9,Included in ER Case rate,571.9,571.9, 589.96 ,541.8
51010428,EAP,CPT® 11601,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Exc Tr-ext Mlg+marg 0.6-1 Cm,1,898, 853.10 ,880.04, 853.10 , 871.06 , 853.10 ,Current Medicare Rates,871.06,862.08,Included in per diem,853.1,Included in ER Case rate,853.1,853.1, 880.04 ,808.2
51010369,EAP,CPT® 40812,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Excise/repair Mouth Lesion,1,258, 245.10 ,252.84, 245.10 , 250.26 , 245.10 ,Current Medicare Rates,250.26,247.68,Included in per diem,245.1,Included in ER Case rate,245.1,245.1, 252.84 ,232.2
51010401,EAP,CPT® 10021,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Fine Needle Aspiration Bx W/o Img Gdn 1st Lesion,1,476.7, 452.87 ,467.17, 452.87 , 462.40 , 452.87 ,Current Medicare Rates,462.4,457.63,Included in per diem,452.87,Included in ER Case rate,452.87,452.87, 467.17 ,429.03
51010004,EAP,CPT® 93792,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Pt/caregiver Trainj Home Inr,1,134, 127.30 ,131.32, 127.30 , 129.98 , 127.30 ,Current Medicare Rates,129.98,128.64,Included in per diem,127.3,Included in ER Case rate,127.3,127.3, 131.32 ,120.6
51010414,EAP,CPT® 11310,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Shave Skin Lesion 0.5 Cm Or Less Face Ers Eyld Nse Lps Muc,1,252, 239.40 ,246.96, 239.40 , 244.44 , 239.40 ,Current Medicare Rates,244.44,241.92,Included in per diem,239.4,Included in ER Case rate,239.4,239.4, 246.96 ,226.8
51010410,EAP,CPT® 11305,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Shave Skin Lesion 0.5 Cm Or Less Sclp Nk Hnd Ft Gen,1,198, 188.10 ,194.04, 188.10 , 192.06 , 188.10 ,Current Medicare Rates,192.06,190.08,Included in per diem,188.1,Included in ER Case rate,188.1,188.1, 194.04 ,178.2
51010440,EAP,CPT® 11719,,0510 - CLINIC - GENERAL CLASSIFICATION,Hc Trim Nail(s),1,62, 58.90 ,60.76, 58.90 , 60.14 , 58.90 ,Current Medicare Rates,60.14,59.52,Included in per diem,58.9,Included in ER Case rate,58.9,58.9, 60.76 ,55.8
52110320,EAP,29435,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 29435 APPLICATION PATELLAR TENDON BEARING CAST RHC,1,291, 276.45 ,285.18, 276.45 , 282.27 , 276.45 ,Current Medicare Rates,282.27,279.36,Included in per diem,276.45,Included in ER Case rate,276.45,276.45, 285.18 ,261.9
52110365,EAP,40810,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 40810 EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR RHC,1,478, 454.10 ,468.44, 454.10 , 463.66 , 454.10 ,Current Medicare Rates,463.66,458.88,Included in per diem,454.1,Included in ER Case rate,454.1,454.1, 468.44 ,430.2
52100023,EAP,93241,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 93241 EXTERNAL ECG REC>48HR<7D SCAN ALYS REPORT R&I RHC,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
52100024,EAP,93244,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 93244 EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION RHC,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
52100019,EAP,93245,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 93245 EXTERNAL ECG REC>7D<15D SCAN ALYS REPORT R&I RHC,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
52100020,EAP,93248,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 93248 EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION RHC,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
52100021,EAP,99417,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 99417 PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN RHC,1,67, 63.65 ,65.66, 63.65 , 64.99 , 63.65 ,Current Medicare Rates,64.99,64.32,Included in per diem,63.65,Included in ER Case rate,63.65,63.65, 65.66 ,60.3
52100022,EAP,99439,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,HC PR 99439 CHRONIC CARE MGMT SRVCS EA ADDL 20 MIN P/ CALENDAR MONTH RHC,1,70.00, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
98311378,EAP,HCPCS G2025,,0521 - CLINIC VISIT BY MEMBER TO RHC/FQHC,Hc Pr G2025 Telehealth Visit Distant Site Fee Cdm,1,290, 275.50 ,284.2, 275.50 , 281.30 , 275.50 ,Current Medicare Rates,281.3,278.4,Included in per diem,275.5,Included in ER Case rate,275.5,275.5, 284.20 ,261
5270001,EAP,HCPCS G0490,,0527 - FREE-STANDING CLINIC - VISITING NURSE SERVICE(S) TO MEMBER'S HOME WHEN IN HOME HEALTH SHORTAGE AREA,"Hc Pr G0490 Home Visit Rn, Lpn By Rhc/fq",1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,Included in per diem,76,Included in ER Case rate,76,76, 78.40 ,72
54010002,EAP,HCPCS A0426,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Ambulance Ground Als Non Emerg,1,"1,149.00"," 1,091.55 ",1126.02," 1,091.55 "," 1,114.53 "," 1,091.55 ",Current Medicare Rates,1114.53,1103.04,Included in per diem,1091.55,Included in ER Case rate,1091.55,1091.55," 1,126.02 ",1034.1
54010003,EAP,HCPCS A0427,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Ambulance Ground Als1 Emrgency,1,"1,982.00"," 1,882.90 ",1942.36," 1,882.90 "," 1,922.54 "," 1,882.90 ",Current Medicare Rates,1922.54,1902.72,Included in per diem,1882.9,Included in ER Case rate,1882.9,1882.9," 1,942.36 ",1783.8
54010008,EAP,HCPCS A0433,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Ambulance Ground Als2 Emrgency,1,"2,501.00"," 2,375.95 ",2450.98," 2,375.95 "," 2,425.97 "," 2,375.95 ",Current Medicare Rates,2425.97,2400.96,Included in per diem,2375.95,Included in ER Case rate,2375.95,2375.95," 2,450.98 ",2250.9
54010005,EAP,HCPCS A0429,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Ambulance Ground Bls Emergency,1,1297," 1,232.15 ",1271.06," 1,232.15 "," 1,258.09 "," 1,232.15 ",Current Medicare Rates,1258.09,1245.12,Included in per diem,1232.15,Included in ER Case rate,1232.15,1232.15," 1,271.06 ",1167.3
54010004,EAP,HCPCS A0428,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Ambulance Ground Bls Non Emerg,1,1002, 951.90 ,981.96, 951.90 , 971.94 , 951.90 ,Current Medicare Rates,971.94,961.92,Included in per diem,951.9,Included in ER Case rate,951.9,951.9, 981.96 ,901.8
54010001,EAP,HCPCS A0425,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Ambulance Ground Per Mile,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
54010144,EAP,HCPCS A0998,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Ambulance Response/treatment-no Transport,1,718, 682.10 ,703.64, 682.10 , 696.46 , 682.10 ,Current Medicare Rates,696.46,689.28,Included in per diem,682.1,Included in ER Case rate,682.1,682.1, 703.64 ,646.2
54010145,EAP,Custom 54010145,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Cab Per Mile Over 67 Mile,1,4, 3.80 ,3.92, 3.80 , 3.88 , 3.80 ,Current Medicare Rates,3.88,3.84,Included in per diem,3.8,Included in ER Case rate,3.8,3.8, 3.92 ,3.6
54010009,EAP,HCPCS A0434,,0540 - AMBULANCE - GENERAL CLASSIFICATION,Hc Specialty Care Transport,1,4342," 4,124.90 ",4255.16," 4,124.90 "," 4,211.74 "," 4,124.90 ",Current Medicare Rates,4211.74,4168.32,Included in per diem,4124.9,Included in ER Case rate,4124.9,4124.9," 4,255.16 ",3907.8
61010085,EAP,CPT® 74182,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Abdomen W/dye,1,3646," 3,463.70 ",3573.08," 3,463.70 "," 3,536.62 "," 3,463.70 ",Current Medicare Rates,3536.62,3500.16,Included in per diem,3463.7,Included in ER Case rate,3463.7,3463.7," 3,573.08 ",3281.4
61010087,EAP,CPT® 74183,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Abdomen W/o & W/dye,1,3050," 2,897.50 ",2989," 2,897.50 "," 2,958.50 "," 2,897.50 ",Current Medicare Rates,2958.5,2928,Included in per diem,2897.5,Included in ER Case rate,2897.5,2897.5," 2,989.00 ",2745
61010083,EAP,CPT® 74181,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Abdomen W/o Dye,1,3050," 2,897.50 ",2989," 2,897.50 "," 2,958.50 "," 2,897.50 ",Current Medicare Rates,2958.5,2928,Included in per diem,2897.5,Included in ER Case rate,2897.5,2897.5," 2,989.00 ",2745
61010145,EAP,CPT® 71555,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Angio Chest W & W/o Dye,1,3621," 3,439.95 ",3548.58," 3,439.95 "," 3,512.37 "," 3,439.95 ",Current Medicare Rates,3512.37,3476.16,Included in per diem,3439.95,Included in ER Case rate,3439.95,3439.95," 3,548.58 ",3258.9
61010022,EAP,CPT® 71551,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Chest W/dye,1,2839," 2,697.05 ",2782.22," 2,697.05 "," 2,753.83 "," 2,697.05 ",Current Medicare Rates,2753.83,2725.44,Included in per diem,2697.05,Included in ER Case rate,2697.05,2697.05," 2,782.22 ",2555.1
61010025,EAP,CPT® 71552,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Chest W/o & W/dye,1,"3,750.00"," 3,562.50 ",3675," 3,562.50 "," 3,637.50 "," 3,562.50 ",Current Medicare Rates,3637.5,3600,Included in per diem,3562.5,Included in ER Case rate,3562.5,3562.5," 3,675.00 ",3375
61010019,EAP,CPT® 71550,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Chest W/o Dye,1,2673," 2,539.35 ",2619.54," 2,539.35 "," 2,592.81 "," 2,539.35 ",Current Medicare Rates,2592.81,2566.08,Included in per diem,2539.35,Included in ER Case rate,2539.35,2539.35," 2,619.54 ",2405.7
61010002,EAP,CPT® 70336,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Image Jaw Joint Tmj,1,2445," 2,322.75 ",2396.1," 2,322.75 "," 2,371.65 "," 2,322.75 ",Current Medicare Rates,2371.65,2347.2,Included in per diem,2322.75,Included in ER Case rate,2322.75,2322.75," 2,396.10 ",2200.5
61010075,EAP,CPT® 73721,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Jnt Of Lwr Extre W/o Dye,1,2575," 2,446.25 ",2523.5," 2,446.25 "," 2,497.75 "," 2,446.25 ",Current Medicare Rates,2497.75,2472,Included in per diem,2446.25,Included in ER Case rate,2446.25,2446.25," 2,523.50 ",2317.5
61010079,EAP,CPT® 73723,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Joint Lwr Extr W/o&w/dye,1,3050," 2,897.50 ",2989," 2,897.50 "," 2,958.50 "," 2,897.50 ",Current Medicare Rates,2958.5,2928,Included in per diem,2897.5,Included in ER Case rate,2897.5,2897.5," 2,989.00 ",2745
61010077,EAP,CPT® 73722,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Joint Of Lwr Extr W/dye,1,3052," 2,899.40 ",2990.96," 2,899.40 "," 2,960.44 "," 2,899.40 ",Current Medicare Rates,2960.44,2929.92,Included in per diem,2899.4,Included in ER Case rate,2899.4,2899.4," 2,990.96 ",2746.8
61010066,EAP,CPT® 73222,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Joint Upr Extrem W/dye,1,3052," 2,899.40 ",2990.96," 2,899.40 "," 2,960.44 "," 2,899.40 ",Current Medicare Rates,2960.44,2929.92,Included in per diem,2899.4,Included in ER Case rate,2899.4,2899.4," 2,990.96 ",2746.8
61010068,EAP,CPT® 73223,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Joint Upr Extrem W/o & W/dye,1,3050," 2,897.50 ",2989," 2,897.50 "," 2,958.50 "," 2,897.50 ",Current Medicare Rates,2958.5,2928,Included in per diem,2897.5,Included in ER Case rate,2897.5,2897.5," 2,989.00 ",2745
61010063,EAP,CPT® 73221,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Joint Upr Extrem W/o Dye,1,2400," 2,280.00 ",2352," 2,280.00 "," 2,328.00 "," 2,280.00 ",Current Medicare Rates,2328,2304,Included in per diem,2280,Included in ER Case rate,2280,2280," 2,352.00 ",2160
61010057,EAP,CPT® 73719,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Lower Extremity W/dye,1,3052," 2,899.40 ",2990.96," 2,899.40 "," 2,960.44 "," 2,899.40 ",Current Medicare Rates,2960.44,2929.92,Included in per diem,2899.4,Included in ER Case rate,2899.4,2899.4," 2,990.96 ",2746.8
61010065,EAP,CPT® 73718,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Lower Extremity W/o Dye,1,2550," 2,422.50 ",2499," 2,422.50 "," 2,473.50 "," 2,422.50 ",Current Medicare Rates,2473.5,2448,Included in per diem,2422.5,Included in ER Case rate,2422.5,2422.5," 2,499.00 ",2295
61010053,EAP,CPT® 73720,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Lwr Extremity W/o&w/dye,1,3050," 2,897.50 ",2989," 2,897.50 "," 2,958.50 "," 2,897.50 ",Current Medicare Rates,2958.5,2928,Included in per diem,2897.5,Included in ER Case rate,2897.5,2897.5," 2,989.00 ",2745
61010142,EAP,CPT® 70540,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Orbit/face/neck W/o Dye,1,2500," 2,375.00 ",2450," 2,375.00 "," 2,425.00 "," 2,375.00 ",Current Medicare Rates,2425,2400,Included in per diem,2375,Included in ER Case rate,2375,2375," 2,450.00 ",2250
61010007,EAP,CPT® 70543,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Orbt/fac/nck W/o & W/dye,1,3250," 3,087.50 ",3185," 3,087.50 "," 3,152.50 "," 3,087.50 ",Current Medicare Rates,3152.5,3120,Included in per diem,3087.5,Included in ER Case rate,3087.5,3087.5," 3,185.00 ",2925
61010038,EAP,CPT® 72196,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Pelvis W/dye,1,3487," 3,312.65 ",3417.26," 3,312.65 "," 3,382.39 "," 3,312.65 ",Current Medicare Rates,3382.39,3347.52,Included in per diem,3312.65,Included in ER Case rate,3312.65,3312.65," 3,417.26 ",3138.3
61010044,EAP,CPT® 72197,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Pelvis W/o & W/dye,1,3050," 2,897.50 ",2989," 2,897.50 "," 2,958.50 "," 2,897.50 ",Current Medicare Rates,2958.5,2928,Included in per diem,2897.5,Included in ER Case rate,2897.5,2897.5," 2,989.00 ",2745
61010029,EAP,CPT® 72195,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Pelvis W/o Dye,1,2450," 2,327.50 ",2401," 2,327.50 "," 2,376.50 "," 2,327.50 ",Current Medicare Rates,2376.5,2352,Included in per diem,2327.5,Included in ER Case rate,2327.5,2327.5," 2,401.00 ",2205
61010137,EAP,CPT® 73219,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Upper Extremity W/dye,1,"2,907.00"," 2,761.65 ",2848.86," 2,761.65 "," 2,819.79 "," 2,761.65 ",Current Medicare Rates,2819.79,2790.72,Included in per diem,2761.65,Included in ER Case rate,2761.65,2761.65," 2,848.86 ",2616.3
61010059,EAP,CPT® 73220,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Upper Extremity W/o & W/dye,1,"2,850.00"," 2,707.50 ",2793," 2,707.50 "," 2,764.50 "," 2,707.50 ",Current Medicare Rates,2764.5,2736,Included in per diem,2707.5,Included in ER Case rate,2707.5,2707.5," 2,793.00 ",2565
61010054,EAP,CPT® 73218,,0610 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION,Hc Mri Upper Extremity W/o Dye,1,2850," 2,707.50 ",2793," 2,707.50 "," 2,764.50 "," 2,707.50 ",Current Medicare Rates,2764.5,2736,Included in per diem,2707.5,Included in ER Case rate,2707.5,2707.5," 2,793.00 ",2565
61110007,EAP,CPT® 70552,,0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM,Hc Mri Brain W/dye,1,3868," 3,674.60 ",3790.64," 3,674.60 "," 3,751.96 "," 3,674.60 ",Current Medicare Rates,3751.96,3713.28,Included in per diem,3674.6,Included in ER Case rate,3674.6,3674.6," 3,790.64 ",3481.2
61110015,EAP,CPT® 70553,,0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM,Hc Mri Brain W/o & W/dye,1,3750," 3,562.50 ",3675," 3,562.50 "," 3,637.50 "," 3,562.50 ",Current Medicare Rates,3637.5,3600,Included in per diem,3562.5,Included in ER Case rate,3562.5,3562.5," 3,675.00 ",3375
61110001,EAP,CPT® 70551,,0611 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM,Hc Mri Brain W/o Dye,1,"2,650.00"," 2,517.50 ",2597," 2,517.50 "," 2,570.50 "," 2,517.50 ",Current Medicare Rates,2570.5,2544,Included in per diem,2517.5,Included in ER Case rate,2517.5,2517.5," 2,597.00 ",2385
61210003,EAP,CPT® 72142,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Cervical Spine W/dye,1,"3,522.00"," 3,345.90 ",3451.56," 3,345.90 "," 3,416.34 "," 3,345.90 ",Current Medicare Rates,3416.34,3381.12,Included in per diem,3345.9,Included in ER Case rate,3345.9,3345.9," 3,451.56 ",3169.8
61210013,EAP,CPT® 72156,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Cervical Spine W/o & W/dye,1,"3,150.00"," 2,992.50 ",3087," 2,992.50 "," 3,055.50 "," 2,992.50 ",Current Medicare Rates,3055.5,3024,Included in per diem,2992.5,Included in ER Case rate,2992.5,2992.5," 3,087.00 ",2835
61210001,EAP,CPT® 72141,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Cervical Spine W/o Dye,1,2600," 2,470.00 ",2548," 2,470.00 "," 2,522.00 "," 2,470.00 ",Current Medicare Rates,2522,2496,Included in per diem,2470,Included in ER Case rate,2470,2470," 2,548.00 ",2340
61210011,EAP,CPT® 72149,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Lumbar Spine W/dye,1,3845," 3,652.75 ",3768.1," 3,652.75 "," 3,729.65 "," 3,652.75 ",Current Medicare Rates,3729.65,3691.2,Included in per diem,3652.75,Included in ER Case rate,3652.75,3652.75," 3,768.10 ",3460.5
61210017,EAP,CPT® 72158,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Lumbar Spine W/o & W/dye,1,4150," 3,942.50 ",4067," 3,942.50 "," 4,025.50 "," 3,942.50 ",Current Medicare Rates,4025.5,3984,Included in per diem,3942.5,Included in ER Case rate,3942.5,3942.5," 4,067.00 ",3735
61210009,EAP,CPT® 72148,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Lumbar Spine W/o Dye,1,"2,900.00"," 2,755.00 ",2842," 2,755.00 "," 2,813.00 "," 2,755.00 ",Current Medicare Rates,2813,2784,Included in per diem,2755,Included in ER Case rate,2755,2755," 2,842.00 ",2610
61210007,EAP,CPT® 72147,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Thoracic Spine W/dye,1,"3,504.00"," 3,328.80 ",3433.92," 3,328.80 "," 3,398.88 "," 3,328.80 ",Current Medicare Rates,3398.88,3363.84,Included in per diem,3328.8,Included in ER Case rate,3328.8,3328.8," 3,433.92 ",3153.6
61210015,EAP,CPT® 72157,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Thoracic Spine W/o & W/dye,1,4150," 3,942.50 ",4067," 3,942.50 "," 4,025.50 "," 3,942.50 ",Current Medicare Rates,4025.5,3984,Included in per diem,3942.5,Included in ER Case rate,3942.5,3942.5," 4,067.00 ",3735
61210005,EAP,CPT® 72146,,0612 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE),Hc Mri Thoracic Spine W/o Dye,1,2800," 2,660.00 ",2744," 2,660.00 "," 2,716.00 "," 2,660.00 ",Current Medicare Rates,2716,2688,Included in per diem,2660,Included in ER Case rate,2660,2660," 2,744.00 ",2520
61010010,EAP,CPT® 70545,,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK,"Hc Mra W/contrast, Head",1,2401," 2,280.95 ",2352.98," 2,280.95 "," 2,328.97 "," 2,280.95 ",Current Medicare Rates,2328.97,2304.96,Included in per diem,2280.95,Included in ER Case rate,2280.95,2280.95," 2,352.98 ",2160.9
61010014,EAP,CPT® 70548,,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK,"Hc Mra W/contrast, Neck",1,2443," 2,320.85 ",2394.14," 2,320.85 "," 2,369.71 "," 2,320.85 ",Current Medicare Rates,2369.71,2345.28,Included in per diem,2320.85,Included in ER Case rate,2320.85,2320.85," 2,394.14 ",2198.7
61010012,EAP,CPT® 70546,,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK,"Hc Mra W/o And W/contrast, Head",1,2986," 2,836.70 ",2926.28," 2,836.70 "," 2,896.42 "," 2,836.70 ",Current Medicare Rates,2896.42,2866.56,Included in per diem,2836.7,Included in ER Case rate,2836.7,2836.7," 2,926.28 ",2687.4
61010015,EAP,CPT® 70549,,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK,"Hc Mra W/o And W/contrast, Neck",1,3660," 3,477.00 ",3586.8," 3,477.00 "," 3,550.20 "," 3,477.00 ",Current Medicare Rates,3550.2,3513.6,Included in per diem,3477,Included in ER Case rate,3477,3477," 3,586.80 ",3294
61010009,EAP,CPT® 70544,,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK,"Hc Mra W/o Contrast, Head",1,3150," 2,992.50 ",3087," 2,992.50 "," 3,055.50 "," 2,992.50 ",Current Medicare Rates,3055.5,3024,Included in per diem,2992.5,Included in ER Case rate,2992.5,2992.5," 3,087.00 ",2835
61010013,EAP,CPT® 70547,,0615 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - HEAD AND NECK,"Hc Mra W/o Contrast, Neck",1,3271," 3,107.45 ",3205.58," 3,107.45 "," 3,172.87 "," 3,107.45 ",Current Medicare Rates,3172.87,3140.16,Included in per diem,3107.45,Included in ER Case rate,3107.45,3107.45," 3,205.58 ",2943.9
61010116,EAP,CPT® 73725,,0616 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - LOWER EXTREMITIES,"HC MRA W/O AND W/CONT, LOWER EXTREMITY",1,"3,131.00"," 2,974.45 ",3068.38," 2,974.45 "," 3,037.07 "," 2,974.45 ",Current Medicare Rates,3037.07,3005.76,Included in per diem,2974.45,Included in ER Case rate,2974.45,2974.45," 3,068.38 ",2817.9
61810001,EAP,CPT® 72198,,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER,Hc Mr Angio Pelvis W/dye,1,2843," 2,700.85 ",2786.14," 2,700.85 "," 2,757.71 "," 2,700.85 ",Current Medicare Rates,2757.71,2729.28,Included in per diem,2700.85,Included in ER Case rate,2700.85,2700.85," 2,786.14 ",2558.7
61010120,EAP,CPT® 72159,,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER,"Hc Mra W/contrast, Spinal Canal",1,2843," 2,700.85 ",2786.14," 2,700.85 "," 2,757.71 "," 2,700.85 ",Current Medicare Rates,2757.71,2729.28,Included in per diem,2700.85,Included in ER Case rate,2700.85,2700.85," 2,786.14 ",2558.7
61010237,EAP,CPT® 74185,,0618 - MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRA - OTHER,Hc Mri Angio Abdom W & W/o Dye,1,3192," 3,032.40 ",3128.16," 3,032.40 "," 3,096.24 "," 3,032.40 ",Current Medicare Rates,3096.24,3064.32,Included in per diem,3032.4,Included in ER Case rate,3032.4,3032.4," 3,128.16 ",2872.8
63610089,EAP,90651,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX 9VHPV VACCINE 2/3 DOSE IM 0.5 ML,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
63610313,EAP,90632,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX HEPATITUS A VACCINE ADULT IM 1 ML,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
63610313,EAP,90632,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX HEPATITUS A VACCINE ADULT IM 1 ML,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
63610313,EAP,90632,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX HEPATITUS A VACCINE ADULT IM 1 ML,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,Included in per diem,114,Included in ER Case rate,114,114, 117.60 ,108
63610337,EAP,J7324,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX HYALURONAN OR DERIVATIVE (ORTHOVISC) INJ 1 EA,1,1148," 1,090.60 ",1125.04," 1,090.60 "," 1,113.56 "," 1,090.60 ",Current Medicare Rates,1113.56,1102.08,Included in per diem,1090.6,Included in ER Case rate,1090.6,1090.6," 1,125.04 ",1033.2
63610258,EAP,J0588,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX INCOBOTULINUMTOXIN A  INJ 1 UNIT,1,10, 9.50 ,9.8, 9.50 , 9.70 , 9.50 ,Current Medicare Rates,9.7,9.6,Included in per diem,9.5,Included in ER Case rate,9.5,9.5, 9.80 ,9
63610258,EAP,J0588,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX INCOBOTULINUMTOXIN A  INJ 1 UNIT,1,10, 9.50 ,9.8, 9.50 , 9.70 , 9.50 ,Current Medicare Rates,9.7,9.6,Included in per diem,9.5,Included in ER Case rate,9.5,9.5, 9.80 ,9
63610258,EAP,J0588,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX INCOBOTULINUMTOXIN A  INJ 1 UNIT,1,10, 9.50 ,9.8, 9.50 , 9.70 , 9.50 ,Current Medicare Rates,9.7,9.6,Included in per diem,9.5,Included in ER Case rate,9.5,9.5, 9.80 ,9
63610258,EAP,J0588,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX INCOBOTULINUMTOXIN A  INJ 1 UNIT,1,10.00, 9.50 ,9.8, 9.50 , 9.70 , 9.50 ,Current Medicare Rates,9.7,9.6,Included in per diem,9.5,Included in ER Case rate,9.5,9.5, 9.80 ,9
63610258,EAP,J0588,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX INCOBOTULINUMTOXIN A  INJ 1 UNIT,1,10.00, 9.50 ,9.8, 9.50 , 9.70 , 9.50 ,Current Medicare Rates,9.7,9.6,Included in per diem,9.5,Included in ER Case rate,9.5,9.5, 9.80 ,9
63610041,EAP,Custom 63610041,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Optime Shell 636,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
98110911,EAP,CPT® 90474,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr 90474 Immune Admin Oral/nasal Addl,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
63610293,EAP,HCPCS 90649,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx 4vhpv Vaccine 3 Dose Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610180,EAP,HCPCS J0702,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Betamethasone Acet&sod Phosp Inj 3 Mg,1,299.00, 284.05 ,293.02, 284.05 , 290.03 , 284.05 ,Current Medicare Rates,290.03,287.04,Included in per diem,284.05,Included in ER Case rate,284.05,284.05, 293.02 ,269.1
63610278,EAP,HCPCS J0696,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Ceftriaxone Sodium Inj 250 Mg,1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
63610279,EAP,HCPCS J0735,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Clonidine Hcl Inj 1 Mg,1,1, 0.95 ,0.98, 0.95 , 0.97 , 0.95 ,Current Medicare Rates,0.97,0.96,Included in per diem,0.95,Included in ER Case rate,0.95,0.95, 0.98 ,0.9
63610545,EAP,HCPCS J1200,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Diphenhydramine Hcl Inj 50 Mg,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,Included in per diem,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
63610294,EAP,HCPCS 90700,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Diphth Tetanus Tox Acell Pertussis Vaccine < 7 Yr Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610295,EAP,HCPCS 90723,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Dtap-hepb-ipv Vaccine Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610296,EAP,HCPCS 90696,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Dtap-ipv Vaccine Child 4-6 Yrs Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610297,EAP,HCPCS 90698,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Dtap-ipv/hib Vaccine Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610335,EAP,HCPCS J7307,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Etonogestrel Implant 1 Ea,1,1260," 1,197.00 ",1234.8," 1,197.00 "," 1,222.20 "," 1,197.00 ",Current Medicare Rates,1222.2,1209.6,Included in per diem,1197,Included in ER Case rate,1197,1197," 1,234.80 ",1134
63610319,EAP,CPT® 90634,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hepatitis Vaccine 3 Dose Ped/adol Im 1 Ea,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610052,EAP,HCPCS 90633,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hepatitus A Vaccine Pediatric 2 Dose Im 0.5 Ml,1,22.00, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
63610298,EAP,HCPCS 90743,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hepb Vaccine Adolescent 2 Dose Im 1 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610299,EAP,HCPCS 90746,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hepb Vaccine Adult 3 Dose Im 1 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610300,EAP,HCPCS 90744,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hepb Vaccine Ped/adolesc 3 Dose Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610301,EAP,HCPCS 90647,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hib Prp-omp Vaccine 3 Dose Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610303,EAP,HCPCS 90748,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hib-hepb Vaccine Im 1 Ea,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610248,EAP,HCPCS 90750,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Hzv Zoster Vaccine Recombinant Adjuvanted Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610111,EAP,HCPCS 90662,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HC PR RX IIV VACCINE PF INCREASED AG CONTENT IM 1 EA,1,42, 39.90 ,41.16, 39.90 , 40.74 , 39.90 ,Current Medicare Rates,40.74,40.32,Included in per diem,39.9,Included in ER Case rate,39.9,39.9, 41.16 ,37.8
63610113,EAP,HCPCS 90688,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Influenza Quadrivalent (iiv4) Im 0.5 Ml,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
63610083,EAP,HCPCS 90685,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Influenza Quadrivalent (iiv4) Pf Im 0.25 Ml,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,Included in per diem,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
63610082,EAP,HCPCS 90686,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Influenza Quadrivalent (iiv4) Pf Im 0.5 Ml,1,29, 27.55 ,28.42, 27.55 , 28.13 , 27.55 ,Current Medicare Rates,28.13,27.84,Included in per diem,27.55,Included in ER Case rate,27.55,27.55, 28.42 ,26.1
63610235,EAP,HCPCS 90682,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Influenza Quadrivalent (riv4) Pf Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610069,EAP,HCPCS 90672,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Influenza Quadrivalent Inh 0.2 Ml,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
63610524,EAP,HCPCS J7300,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Intrauterine Copper Contraceptive Iud 1 Ea,1,1282," 1,217.90 ",1256.36," 1,217.90 "," 1,243.54 "," 1,217.90 ",Current Medicare Rates,1243.54,1230.72,Included in per diem,1217.9,Included in ER Case rate,1217.9,1217.9," 1,256.36 ",1153.8
63610289,EAP,HCPCS J1885,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Ketorolac Tromethamine Inj 15 Mg,1,46.00, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
63610217,EAP,HCPCS J7298,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Levonorgestrel Iud (mirena) Iud 5 Yr 52 Mg,1,1718," 1,632.10 ",1683.64," 1,632.10 "," 1,666.46 "," 1,632.10 ",Current Medicare Rates,1666.46,1649.28,Included in per diem,1632.1,Included in ER Case rate,1632.1,1632.1," 1,683.64 ",1546.2
63610054,EAP,HCPCS 90707,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Measles Mumps Rubella Vaccine Live Sq 1 Ea,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610305,EAP,HCPCS 90734,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Menacwyd/menacwy-crm Conj Vaccine Grps Acyw Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610193,EAP,HCPCS J1040,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Methylprednisolone Acetate Inj 80 Mg,1,64, 60.80 ,62.72, 60.80 , 62.08 , 60.80 ,Current Medicare Rates,62.08,61.44,Included in per diem,60.8,Included in ER Case rate,60.8,60.8, 62.72 ,57.6
63610534,EAP,HCPCS J2270,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Morphine Sulfate Inj 10 Mg,1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,Included in per diem,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
63610333,EAP,HCPCS J7030,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Normal Saline Infusion 1000 Ml,1,13, 12.35 ,12.74, 12.35 , 12.61 , 12.35 ,Current Medicare Rates,12.61,12.48,Included in per diem,12.35,Included in ER Case rate,12.35,12.35, 12.74 ,11.7
63610093,EAP,HCPCS 90670,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Pneumococcal Vaccine 13 Valent Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610058,EAP,HCPCS 90732,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Pneumococcal Vaccine 23 Valent 2 Yrs Or Older Sq/im 0.5 Ml,1,22.00, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
63610055,EAP,HCPCS 90713,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Poliovirus Vaccine Inactivated Sq/im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610355,EAP,HCPCS J0780,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Prochlorperazine Inj 10 Mg,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,Included in per diem,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
63610536,EAP,HCPCS J2550,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Promethazine Hcl Inj 50 Mg,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610194,EAP,HCPCS J2790,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Rho D Immune Globulin Inj 300 Mcg (1500 Iu),1,353, 335.35 ,345.94, 335.35 , 342.41 , 335.35 ,Current Medicare Rates,342.41,338.88,Included in per diem,335.35,Included in ER Case rate,335.35,335.35, 345.94 ,317.7
63610310,EAP,HCPCS 90680,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Rotovirus Vaccine (rv5) 3 Dose Oral 2 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610038,EAP,HCPCS 90714,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Td Vaccine Pf 7 Yrs Or Older Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610056,EAP,HCPCS 90715,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Tdap Vaccine 7 Yrs Or Older Im 0.5 Ml,1,21.96, 20.86 ,21.52, 20.86 , 21.30 , 20.86 ,Current Medicare Rates,21.3,21.08,Included in per diem,20.86,Included in ER Case rate,20.86,20.86, 21.52 ,19.764
63610157,EAP,HCPCS J1071,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Testosterone Cypionate Inj 1 Mg,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
63610250,EAP,HCPCS J3301,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Triamcinolone Acetate Inj 10 Mg,1,16, 15.20 ,15.68, 15.20 , 15.52 , 15.20 ,Current Medicare Rates,15.52,15.36,Included in per diem,15.2,Included in ER Case rate,15.2,15.2, 15.68 ,14.4
63610057,EAP,HCPCS 90716,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Varicella Vaccine Live Sq 0.5 Ml,1,22.00, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,Included in per diem,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
63610135,EAP,HCPCS J3420,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Hc Pr Rx Vitamin B12 Inj 1000 Mcg,1,20, 19.00 ,19.6, 19.00 , 19.40 , 19.00 ,Current Medicare Rates,19.4,19.2,Included in per diem,19,Included in ER Case rate,19,19, 19.60 ,18
98310972,EAP,CPT® 90688,,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),Iiv4 Vacc Split Virus 0.5 Ml Dos For Im Use,1,0.00, -   ,0, -   , -   , -   ,Current Medicare Rates,0,0,Included in per diem,0,Included in ER Case rate,0,0, -   ,0
Rx00002831517,RX,J1815,00002831517,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INSULIN NPH (HUMAN) (ISOPHANE) INJ 100 UNIT/ML,1,24.37, 23.15 ,23.88, 23.15 , 23.64 , 23.15 ,Current Medicare Rates,23.64,23.4,Included in per diem,23.15,Included in ER Case rate,23.15,23.15, 23.88 ,21.933
Rx00169183711,RX,J1815,00169183711,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INSULIN NPH ISOPHANE & REGULAR HUMAN INJ 100 UNIT/ML (70-30),1,161.38, 153.31 ,158.15, 153.31 , 156.54 , 153.31 ,Current Medicare Rates,156.54,154.92,Included in per diem,153.31,Included in ER Case rate,153.31,153.31, 158.15 ,145.242
Rx00002821517,RX,J1815,00002821517,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INSULIN REGULAR (HUMAN) INJ 100 UNIT/ML,1,24.37, 23.15 ,23.88, 23.15 , 23.64 , 23.15 ,Current Medicare Rates,23.64,23.4,Included in per diem,23.15,Included in ER Case rate,23.15,23.15, 23.88 ,21.933
Rx00143956410,RX,J2760,00143956410,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHENTOLAMINE MESYLATE FOR INJ 5 MG,1,1309.88," 1,244.39 ",1283.68," 1,244.39 "," 1,270.58 "," 1,244.39 ",Current Medicare Rates,1270.58,1257.48,Included in per diem,1244.39,Included in ER Case rate,1244.39,1244.39," 1,283.68 ",1178.892
Rx00002751017,RX,J1815,00002751017,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INSULIN LISPRO INJ 100 UNIT/ML,1,66.5, 63.18 ,65.17, 63.18 , 64.51 , 63.18 ,Current Medicare Rates,64.51,63.84,Included in per diem,63.18,Included in ER Case rate,63.18,63.18, 65.17 ,59.85
Rx00088222033,RX,J1815,00088222033,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INSULIN GLARGINE INJ 100 UNIT/ML,1,263.11, 249.95 ,257.85, 249.95 , 255.22 , 249.95 ,Current Medicare Rates,255.22,252.59,Included in per diem,249.95,Included in ER Case rate,249.95,249.95, 257.85 ,236.799
Rx00169750111,RX,J1815,00169750111,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INSULIN ASPART INJ 100 UNIT/ML,1,341.61, 324.53 ,334.78, 324.53 , 331.36 , 324.53 ,Current Medicare Rates,331.36,327.95,Included in per diem,324.53,Included in ER Case rate,324.53,324.53, 334.78 ,307.449
Rx00002751017,RX,J1815,00002751017,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"INSULIN LISPRO INJ 100 UNIT/ML,INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (0.5 UNIT DIAL),INSULIN LISPRO SOLN PEN-INJECTOR 100 UNIT/ML (1 UNIT DIAL)",1,66.5, 63.18 ,65.17, 63.18 , 64.51 , 63.18 ,Current Medicare Rates,64.51,63.84,Included in per diem,63.18,Included in ER Case rate,63.18,63.18, 65.17 ,59.85
Rx00000004379,RX,J1815,00000004379,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INSULIN REGULAR 1 UNIT/ML IN NS INJ INTERMITTENT,1,26.65, 25.32 ,26.12, 25.32 , 25.85 , 25.32 ,Current Medicare Rates,25.85,25.58,Included in per diem,25.32,Included in ER Case rate,25.32,25.32, 26.12 ,23.985
Rx63323037805,RX,J2354,63323037805,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021045405,RX,J2354,25021045405,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OCTREOTIDE ACETATE INJ 200 MCG/ML (0.2 MG/ML),1,29.12, 27.66 ,28.54, 27.66 , 28.25 , 27.66 ,Current Medicare Rates,28.25,27.96,Included in per diem,27.66,Included in ER Case rate,27.66,27.66, 28.54 ,26.208
Rx65649055103,RX,J2212,65649055103,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLNALTREXONE BROMIDE INJ 12 MG/0.6ML (20 MG/ML),1,277.34, 263.47 ,271.79, 263.47 , 269.02 , 263.47 ,Current Medicare Rates,269.02,266.25,Included in per diem,263.47,Included in ER Case rate,263.47,263.47, 271.79 ,249.606
Rx67457067502,RX,J0630,67457067502,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CALCITONIN (SALMON) INJ 200 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781317471,RX,J3030,00781317471,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML,1,226.99, 215.64 ,222.45, 215.64 , 220.18 , 215.64 ,Current Medicare Rates,220.18,217.91,Included in per diem,215.64,Included in ER Case rate,215.64,215.64, 222.45 ,204.291
Rx55150017301,RX,J3030,55150017301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SUMATRIPTAN SUCCINATE INJ 6 MG/0.5ML,1,22.37, 21.25 ,21.92, 21.25 , 21.70 , 21.25 ,Current Medicare Rates,21.7,21.48,Included in per diem,21.25,Included in ER Case rate,21.25,21.25, 21.92 ,20.133
Rx69724011210,RX,C9482,69724011210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SOTALOL HCL INJ 150 MG/10ML (15 MG/ML),1,4717.17," 4,481.31 ",4622.83," 4,481.31 "," 4,575.65 "," 4,481.31 ",Current Medicare Rates,4575.65,4528.48,Included in per diem,4481.31,Included in ER Case rate,4481.31,4481.31," 4,622.83 ",4245.453
Rx00264780510,RX,J7131,00264780510,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SODIUM CHLORIDE IV SOLN 3%,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00338005403,RX,J7131,00338005403,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SODIUM CHLORIDE IV SOLN 3%,1,93.98, 89.28 ,92.1, 89.28 , 91.16 , 89.28 ,Current Medicare Rates,91.16,90.22,Included in per diem,89.28,Included in ER Case rate,89.28,89.28, 92.10 ,84.582
Rx00338604648,RX,J1450,00338604648,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML,1,53.68, 51.00 ,52.61, 51.00 , 52.07 , 51.00 ,Current Medicare Rates,52.07,51.53,Included in per diem,51,Included in ER Case rate,51,51, 52.61 ,48.312
Rx25021018482,RX,J1450,25021018482,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML,1,47.74, 45.35 ,46.79, 45.35 , 46.31 , 45.35 ,Current Medicare Rates,46.31,45.83,Included in per diem,45.35,Included in ER Case rate,45.35,45.35, 46.79 ,42.966
Rx24201023701,RX,J9185,24201023701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUDARABINE PHOSPHATE FOR INJ 50 MG,1,453.50, 430.83 ,444.43, 430.83 , 439.90 , 430.83 ,Current Medicare Rates,439.9,435.36,Included in per diem,430.83,Included in ER Case rate,430.83,430.83, 444.43 ,408.15
Rx00005197101,RX,90670,00005197101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PNEUMOCOCCAL 13-VALENT CONJUGATE VACCINE INJ,1,651, 618.45 ,637.98, 618.45 , 631.47 , 618.45 ,Current Medicare Rates,631.47,624.96,Included in per diem,618.45,Included in ER Case rate,618.45,618.45, 637.98 ,585.9
Rx00409272001,RX,J1644,00409272001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021040001,RX,J1644,25021040001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,1,21.69, 20.61 ,21.26, 20.61 , 21.04 , 20.61 ,Current Medicare Rates,21.04,20.82,Included in per diem,20.61,Included in ER Case rate,20.61,20.61, 21.26 ,19.521
Rx00409272030,RX,J1644,00409272030,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457037212,RX,J1644,67457037212,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,1,23.71, 22.52 ,23.24, 22.52 , 23.00 , 22.52 ,Current Medicare Rates,23,22.76,Included in per diem,22.52,Included in ER Case rate,22.52,22.52, 23.24 ,21.339
Rx67457037299,RX,J1644,67457037299,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 1000 UNIT/ML,1,23.63, 22.45 ,23.16, 22.45 , 22.92 , 22.45 ,Current Medicare Rates,22.92,22.68,Included in per diem,22.45,Included in ER Case rate,22.45,22.45, 23.16 ,21.267
Rx00409272101,RX,J1644,00409272101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021040301,RX,J1644,25021040301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409272130,RX,J1644,00409272130,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 10000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021040201,RX,J1644,25021040201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641040037,RX,J1644,00641040037,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457037412,RX,J1644,67457037412,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457037499,RX,J1644,67457037499,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323026201,RX,J1644,63323026201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) INJ 5000 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409427902,RX,J2001,00409427902,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049257,RX,J2001,63323049257,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049227,RX,J2001,63323049227,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049216,RX,J2001,63323049216,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049226,RX,J2001,63323049226,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049207,RX,J2001,63323049207,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049209,RX,J2001,63323049209,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049507,RX,J2001,63323049507,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323049504,RX,J2001,63323049504,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323020805,RX,J2001,63323020805,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL PRESERVATIVE FREE (PF) INJ 2%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00338069104,RX,J3480,00338069104,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KCL 20 MEQ/L (0.15%) IN NACL 0.9% INJ,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx00338069504,RX,J3480,00338069504,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KCL 40 MEQ/L (0.3%) IN NACL 0.9% INJ,1,101.71, 96.62 ,99.68, 96.62 , 98.66 , 96.62 ,Current Medicare Rates,98.66,97.64,Included in per diem,96.62,Included in ER Case rate,96.62,96.62, 99.68 ,91.539
Rx67457022005,RX,Q9968,67457022005,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ISOSULFAN BLUE SUBCUTANEOUS SOLN 1%,1,899.51, 854.53 ,881.52, 854.53 , 872.52 , 854.53 ,Current Medicare Rates,872.52,863.53,Included in per diem,854.53,Included in ER Case rate,854.53,854.53, 881.52 ,809.559
Rx00074364203,RX,J9217,00074364203,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEUPROLIDE ACETATE FOR INJ KIT 7.5 MG,1,389.68, 370.20 ,381.89, 370.20 , 377.99 , 370.20 ,Current Medicare Rates,377.99,374.09,Included in per diem,370.2,Included in ER Case rate,370.2,370.2, 381.89 ,350.712
Rx00641604401,RX,J2060,00641604401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LORAZEPAM INJ 2 MG/ML,1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00641604425,RX,J2060,00641604425,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LORAZEPAM INJ 2 MG/ML,1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00641620701,RX,J2060,00641620701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LORAZEPAM INJ 2 MG/ML,1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx17478050101,RX,J2210,17478050101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLERGONOVINE MALEATE INJ 0.2 MG/ML,1,144.7, 137.47 ,141.81, 137.47 , 140.36 , 137.47 ,Current Medicare Rates,140.36,138.91,Included in per diem,137.47,Included in ER Case rate,137.47,137.47, 141.81 ,130.23
Rx51991014417,RX,J2210,51991014417,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLERGONOVINE MALEATE INJ 0.2 MG/ML,1,202.61, 192.48 ,198.56, 192.48 , 196.53 , 192.48 ,Current Medicare Rates,196.53,194.51,Included in per diem,192.48,Included in ER Case rate,192.48,192.48, 198.56 ,182.349
Rx00009069801,RX,J2930,00009069801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE SOD SUCC FOR INJ 1000 MG (BASE EQUIV),1,146.32, 139.00 ,143.39, 139.00 , 141.93 , 139.00 ,Current Medicare Rates,141.93,140.47,Included in per diem,139,Included in ER Case rate,139,139, 143.39 ,131.688
Rx00009004725,RX,J2930,00009004725,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE SOD SUCC FOR INJ 125 MG (BASE EQUIV),1,32.95, 31.30 ,32.29, 31.30 , 31.96 , 31.30 ,Current Medicare Rates,31.96,31.63,Included in per diem,31.3,Included in ER Case rate,31.3,31.3, 32.29 ,29.655
Rx00009003930,RX,J2920,00009003930,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE SOD SUCC FOR INJ 40 MG (BASE EQUIV),1,21.85, 20.76 ,21.41, 20.76 , 21.19 , 20.76 ,Current Medicare Rates,21.19,20.98,Included in per diem,20.76,Included in ER Case rate,20.76,20.76, 21.41 ,19.665
Rx60793060010,RX,J0558,60793060010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML,1,424.35, 403.13 ,415.86, 403.13 , 411.62 , 403.13 ,Current Medicare Rates,411.62,407.38,Included in per diem,403.13,Included in ER Case rate,403.13,403.13, 415.86 ,381.915
Rx60793060002,RX,J0558,60793060002,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML,1,425.73, 404.44 ,417.22, 404.44 , 412.96 , 404.44 ,Current Medicare Rates,412.96,408.7,Included in per diem,404.44,Included in ER Case rate,404.44,404.44, 417.22 ,383.157
Rx60793060102,RX,J0558,60793060102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PENICILLIN G BENZATHINE & PROCAINE INJ SUSP 1200000 UNIT/2ML,1,425.73, 404.44 ,417.22, 404.44 , 412.96 , 404.44 ,Current Medicare Rates,412.96,408.7,Included in per diem,404.44,Included in ER Case rate,404.44,404.44, 417.22 ,383.157
Rx50242013501,RX,J3262,50242013501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TOCILIZUMAB IV INJ 80 MG/4ML,1,811.88, 771.29 ,795.64, 771.29 , 787.52 , 771.29 ,Current Medicare Rates,787.52,779.4,Included in per diem,771.29,Included in ER Case rate,771.29,771.29, 795.64 ,730.692
Rx50242013601,RX,J3262,50242013601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TOCILIZUMAB IV INJ 200 MG/10ML,1,2029.66," 1,928.18 ",1989.07," 1,928.18 "," 1,968.77 "," 1,928.18 ",Current Medicare Rates,1968.77,1948.47,Included in per diem,1928.18,Included in ER Case rate,1928.18,1928.18," 1,989.07 ",1826.694
Rx50242006001,RX,J9035,50242006001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BEVACIZUMAB IV SOLN 100 MG/4ML (FOR INFUSION),1,"1,736.49"," 1,649.67 ",1701.76," 1,649.67 "," 1,684.40 "," 1,649.67 ",Current Medicare Rates,1684.4,1667.03,Included in per diem,1649.67,Included in ER Case rate,1649.67,1649.67," 1,701.76 ",1562.841
Rx50242006101,RX,J9035,50242006101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BEVACIZUMAB IV SOLN 400 MG/16ML (FOR INFUSION),1,6636.95," 6,305.10 ",6504.21," 6,305.10 "," 6,437.84 "," 6,305.10 ",Current Medicare Rates,6437.84,6371.47,Included in per diem,6305.1,Included in ER Case rate,6305.1,6305.1," 6,504.21 ",5973.255
Rx66733095823,RX,J9055,66733095823,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CETUXIMAB IV SOLN 200 MG/100ML (2 MG/ML),1,2742.47," 2,605.35 ",2687.62," 2,605.35 "," 2,660.20 "," 2,605.35 ",Current Medicare Rates,2660.2,2632.77,Included in per diem,2605.35,Included in ER Case rate,2605.35,2605.35," 2,687.62 ",2468.223
Rx55513092401,RX,J1442,55513092401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML,1,1034.38, 982.66 ,1013.69, 982.66 ," 1,003.35 ", 982.66 ,Current Medicare Rates,1003.35,993,Included in per diem,982.66,Included in ER Case rate,982.66,982.66," 1,013.69 ",930.942
Rx55513092410,RX,J1442,55513092410,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML,1,1032.06, 980.46 ,1011.42, 980.46 ," 1,001.10 ", 980.46 ,Current Medicare Rates,1001.1,990.78,Included in per diem,980.46,Included in ER Case rate,980.46,980.46," 1,011.42 ",928.854
Rx55513020991,RX,J1442,55513020991,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML (600 MCG/ML),1,935.58, 888.80 ,916.87, 888.80 , 907.51 , 888.80 ,Current Medicare Rates,907.51,898.16,Included in per diem,888.8,Included in ER Case rate,888.8,888.8, 916.87 ,842.022
Rx55513020901,RX,J1442,55513020901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FILGRASTIM SOLN PREFILLED SYRINGE 480 MCG/0.8ML (600 MCG/ML),1,937.67, 890.79 ,918.92, 890.79 , 909.54 , 890.79 ,Current Medicare Rates,909.54,900.16,Included in per diem,890.79,Included in ER Case rate,890.79,890.79, 918.92 ,843.903
Rx00310072010,RX,J9395,00310072010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FULVESTRANT INJ 250 MG/5ML,1,1706.84," 1,621.50 ",1672.7," 1,621.50 "," 1,655.63 "," 1,621.50 ",Current Medicare Rates,1655.63,1638.57,Included in per diem,1621.5,Included in ER Case rate,1621.5,1621.5," 1,672.70 ",1536.156
Rx70860021174,RX,J9395,70860021174,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FULVESTRANT INJ 250 MG/5ML,1,989.21, 939.75 ,969.43, 939.75 , 959.53 , 939.75 ,Current Medicare Rates,959.53,949.64,Included in per diem,939.75,Included in ER Case rate,939.75,939.75, 969.43 ,890.289
Rx25021013281,RX,J1956,25021013281,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML,1,126.25, 119.94 ,123.73, 119.94 , 122.46 , 119.94 ,Current Medicare Rates,122.46,121.2,Included in per diem,119.94,Included in ER Case rate,119.94,119.94, 123.73 ,113.625
Rx00781334152,RX,J1956,00781334152,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML,1,127.33, 120.96 ,124.78, 120.96 , 123.51 , 120.96 ,Current Medicare Rates,123.51,122.24,Included in per diem,120.96,Included in ER Case rate,120.96,120.96, 124.78 ,114.597
Rx36000004624,RX,J1956,36000004624,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML,1,187.48, 178.11 ,183.73, 178.11 , 181.86 , 178.11 ,Current Medicare Rates,181.86,179.98,Included in per diem,178.11,Included in ER Case rate,178.11,178.11, 183.73 ,168.732
Rx36000029424,RX,J1956,36000029424,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVOFLOXACIN IN D5W IV SOLN 250 MG/50ML,1,90.27, 85.76 ,88.46, 85.76 , 87.56 , 85.76 ,Current Medicare Rates,87.56,86.66,Included in per diem,85.76,Included in ER Case rate,85.76,85.76, 88.46 ,81.243
Rx25021013282,RX,J1956,25021013282,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,1,185.81, 176.52 ,182.09, 176.52 , 180.24 , 176.52 ,Current Medicare Rates,180.24,178.38,Included in per diem,176.52,Included in ER Case rate,176.52,176.52, 182.09 ,167.229
Rx36000004724,RX,J1956,36000004724,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVOFLOXACIN IN D5W IV SOLN 500 MG/100ML,1,190.49, 180.97 ,186.68, 180.97 , 184.78 , 180.97 ,Current Medicare Rates,184.78,182.87,Included in per diem,180.97,Included in ER Case rate,180.97,180.97, 186.68 ,171.441
Rx25021013283,RX,J1956,25021013283,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVOFLOXACIN IN D5W IV SOLN 750 MG/150ML,1,187.65, 178.27 ,183.9, 178.27 , 182.02 , 178.27 ,Current Medicare Rates,182.02,180.14,Included in per diem,178.27,Included in ER Case rate,178.27,178.27, 183.90 ,168.885
Rx72485021504,RX,J9171,72485021504,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),1,203.71, 193.52 ,199.64, 193.52 , 197.60 , 193.52 ,Current Medicare Rates,197.6,195.56,Included in per diem,193.52,Included in ER Case rate,193.52,193.52, 199.64 ,183.339
Rx47335089540,RX,J9171,47335089540,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOCETAXEL FOR INJ CONC 80 MG/4ML (20 MG/ML),1,250.33, 237.81 ,245.32, 237.81 , 242.82 , 237.81 ,Current Medicare Rates,242.82,240.32,Included in per diem,237.81,Included in ER Case rate,237.81,237.81, 245.32 ,225.297
Rx00409477723,RX,J0744,00409477723,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CIPROFLOXACIN 200 MG/100ML IN D5W,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx36000000824,RX,J0744,36000000824,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CIPROFLOXACIN 200 MG/100ML IN D5W,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00781323946,RX,J0744,00781323946,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CIPROFLOXACIN 200 MG/100ML IN D5W,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00009752905,RX,J9206,00009752905,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IRINOTECAN HCL INJ 300 MG/15ML (20 MG/ML),1,197.75, 187.86 ,193.8, 187.86 , 191.82 , 187.86 ,Current Medicare Rates,191.82,189.84,Included in per diem,187.86,Included in ER Case rate,187.86,187.86, 193.80 ,177.975
Rx00409020120,RX,J9171,00409020120,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOCETAXEL SOLN FOR IV INFUSION 160 MG/16ML,1,721, 684.95 ,706.58, 684.95 , 699.37 , 684.95 ,Current Medicare Rates,699.37,692.16,Included in per diem,684.95,Included in ER Case rate,684.95,684.95, 706.58 ,648.9
Rx00003232711,RX,J9228,00003232711,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IPILIMUMAB SOLN FOR IV INFUSION 50 MG/10ML (5 MG/ML),1,14435.8," 13,714.01 ",14147.08," 13,714.01 "," 14,002.73 "," 13,714.01 ",Current Medicare Rates,14002.73,13858.37,Included in per diem,13714.01,Included in ER Case rate,13714.01,13714.01," 14,147.08 ",12992.22
Rx00955100310,RX,J1650,00955100310,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 30 MG/0.3ML,1,124.36, 118.14 ,121.87, 118.14 , 120.63 , 118.14 ,Current Medicare Rates,120.63,119.39,Included in per diem,118.14,Included in ER Case rate,118.14,118.14, 121.87 ,111.924
Rx00075801301,RX,J1650,00075801301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 30 MG/0.3ML,1,186.24, 176.93 ,182.52, 176.93 , 180.65 , 176.93 ,Current Medicare Rates,180.65,178.79,Included in per diem,176.93,Included in ER Case rate,176.93,176.93, 182.52 ,167.616
Rx00955100301,RX,J1650,00955100301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 30 MG/0.3ML,1,124.43, 118.21 ,121.94, 118.21 , 120.70 , 118.21 ,Current Medicare Rates,120.7,119.45,Included in per diem,118.21,Included in ER Case rate,118.21,118.21, 121.94 ,111.987
Rx00548560200,RX,J1650,00548560200,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,122.98, 116.83 ,120.52, 116.83 , 119.29 , 116.83 ,Current Medicare Rates,119.29,118.06,Included in per diem,116.83,Included in ER Case rate,116.83,116.83, 120.52 ,110.682
Rx00781322402,RX,J1650,00781322402,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,162.08, 153.98 ,158.84, 153.98 , 157.22 , 153.98 ,Current Medicare Rates,157.22,155.6,Included in per diem,153.98,Included in ER Case rate,153.98,153.98, 158.84 ,145.872
Rx00955100410,RX,J1650,00955100410,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,131.44, 124.87 ,128.81, 124.87 , 127.50 , 124.87 ,Current Medicare Rates,127.5,126.18,Included in per diem,124.87,Included in ER Case rate,124.87,124.87, 128.81 ,118.296
Rx00075801401,RX,J1650,00075801401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,213.98, 203.28 ,209.7, 203.28 , 207.56 , 203.28 ,Current Medicare Rates,207.56,205.42,Included in per diem,203.28,Included in ER Case rate,203.28,203.28, 209.70 ,192.582
Rx00075801410,RX,J1650,00075801410,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,213.98, 203.28 ,209.7, 203.28 , 207.56 , 203.28 ,Current Medicare Rates,207.56,205.42,Included in per diem,203.28,Included in ER Case rate,203.28,203.28, 209.70 ,192.582
Rx00703854021,RX,J1650,00703854021,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,189.31, 179.84 ,185.52, 179.84 , 183.63 , 179.84 ,Current Medicare Rates,183.63,181.74,Included in per diem,179.84,Included in ER Case rate,179.84,179.84, 185.52 ,170.379
Rx60505079200,RX,J1650,60505079200,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,123.17, 117.01 ,120.71, 117.01 , 119.47 , 117.01 ,Current Medicare Rates,119.47,118.24,Included in per diem,117.01,Included in ER Case rate,117.01,117.01, 120.71 ,110.853
Rx60505079204,RX,J1650,60505079204,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,122.98, 116.83 ,120.52, 116.83 , 119.29 , 116.83 ,Current Medicare Rates,119.29,118.06,Included in per diem,116.83,Included in ER Case rate,116.83,116.83, 120.52 ,110.682
Rx00955100401,RX,J1650,00955100401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 40 MG/0.4ML,1,131.53, 124.95 ,128.9, 124.95 , 127.58 , 124.95 ,Current Medicare Rates,127.58,126.27,Included in per diem,124.95,Included in ER Case rate,124.95,124.95, 128.90 ,118.377
Rx00955100610,RX,J1650,00955100610,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM SUBCUTANEOUS SOLN 60 MG/0.6ML,1,134.5, 127.78 ,131.81, 127.78 , 130.47 , 127.78 ,Current Medicare Rates,130.47,129.12,Included in per diem,127.78,Included in ER Case rate,127.78,127.78, 131.81 ,121.05
Rx00075062160,RX,J1650,00075062160,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM SUBCUTANEOUS SOLN 60 MG/0.6ML,1,240.86, 228.82 ,236.04, 228.82 , 233.63 , 228.82 ,Current Medicare Rates,233.63,231.23,Included in per diem,228.82,Included in ER Case rate,228.82,228.82, 236.04 ,216.774
Rx00955100810,RX,J1650,00955100810,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM SUBCUTANEOUS SOLN 80 MG/0.8ML,1,138.71, 131.77 ,135.94, 131.77 , 134.55 , 131.77 ,Current Medicare Rates,134.55,133.16,Included in per diem,131.77,Included in ER Case rate,131.77,131.77, 135.94 ,124.839
Rx00955100801,RX,J1650,00955100801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM SUBCUTANEOUS SOLN 80 MG/0.8ML,1,138.71, 131.77 ,135.94, 131.77 , 134.55 , 131.77 ,Current Medicare Rates,134.55,133.16,Included in per diem,131.77,Included in ER Case rate,131.77,131.77, 135.94 ,124.839
Rx00955101010,RX,J1650,00955101010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 100 MG/ML,1,167.05, 158.70 ,163.71, 158.70 , 162.04 , 158.70 ,Current Medicare Rates,162.04,160.37,Included in per diem,158.7,Included in ER Case rate,158.7,158.7, 163.71 ,150.345
Rx00955101210,RX,J1650,00955101210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ENOXAPARIN SODIUM INJ 120 MG/0.8ML,1,165.96, 157.66 ,162.64, 157.66 , 160.98 , 157.66 ,Current Medicare Rates,160.98,159.32,Included in per diem,157.66,Included in ER Case rate,157.66,157.66, 162.64 ,149.364
Rx49281040388,RX,90662,49281040388,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLUENZA VIRUS VAC SPLIT HIGH-DOSE PF SUSP PREF SYR 0.5ML,1,162.79, 154.65 ,159.53, 154.65 , 157.91 , 154.65 ,Current Medicare Rates,157.91,156.28,Included in per diem,154.65,Included in ER Case rate,154.65,154.65, 159.53 ,146.511
Rx43598040516,RX,J3430,43598040516,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHYTONADIONE INJ 10 MG/ML,1,20.61, 19.58 ,20.2, 19.58 , 19.99 , 19.58 ,Current Medicare Rates,19.99,19.79,Included in per diem,19.58,Included in ER Case rate,19.58,19.58, 20.20 ,18.549
Rx00006394132,RX,J1453,00006394132,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOSAPREPITANT DIMEGLUMINE FOR IV INFUSION 150 MG (BASE EQ),1,957.71, 909.82 ,938.56, 909.82 , 928.98 , 909.82 ,Current Medicare Rates,928.98,919.4,Included in per diem,909.82,Included in ER Case rate,909.82,909.82, 938.56 ,861.939
Rx55513073001,RX,J0897,55513073001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DENOSUMAB INJ 120 MG/1.7ML,1,4385.45," 4,166.18 ",4297.74," 4,166.18 "," 4,253.89 "," 4,166.18 ",Current Medicare Rates,4253.89,4210.03,Included in per diem,4166.18,Included in ER Case rate,4166.18,4166.18," 4,297.74 ",3946.905
Rx00006494301,RX,90732,00006494301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PNEUMOCOCCAL VACCINE POLYVALENT INJ 25 MCG/0.5ML,1,332.43, 315.81 ,325.78, 315.81 , 322.46 , 315.81 ,Current Medicare Rates,322.46,319.13,Included in per diem,315.81,Included in ER Case rate,315.81,315.81, 325.78 ,299.187
Rx00006483701,RX,90732,00006483701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PNEUMOCOCCAL VACCINE POLYVALENT INJ 25 MCG/0.5ML,1,332.43, 315.81 ,325.78, 315.81 , 322.46 , 315.81 ,Current Medicare Rates,322.46,319.13,Included in per diem,315.81,Included in ER Case rate,315.81,315.81, 325.78 ,299.187
Rx00456060001,RX,J0712,00456060001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG,1,647.35, 614.98 ,634.4, 614.98 , 627.93 , 614.98 ,Current Medicare Rates,627.93,621.46,Included in per diem,614.98,Included in ER Case rate,614.98,614.98, 634.40 ,582.615
Rx00456060010,RX,J0712,00456060010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTAROLINE FOSAMIL FOR IV SOLN 600 MG,1,589.57, 560.09 ,577.78, 560.09 , 571.88 , 560.09 ,Current Medicare Rates,571.88,565.99,Included in per diem,560.09,Included in ER Case rate,560.09,560.09, 577.78 ,530.613
Rx00944270005,RX,J1569,00944270005,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 10 GM/100ML,1,"1,342.04"," 1,274.94 ",1315.2," 1,274.94 "," 1,301.78 "," 1,274.94 ",Current Medicare Rates,1301.78,1288.36,Included in per diem,1274.94,Included in ER Case rate,1274.94,1274.94," 1,315.20 ",1207.836
Rx00944270006,RX,J1569,00944270006,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IMMUNE GLOBULIN (HUMAN) IV OR SUBCUTANEOUS SOLN 20 GM/200ML,1,"2,684.08"," 2,549.88 ",2630.4," 2,549.88 "," 2,603.56 "," 2,549.88 ",Current Medicare Rates,2603.56,2576.72,Included in per diem,2549.88,Included in ER Case rate,2549.88,2549.88," 2,630.40 ",2415.672
Rx00409707426,RX,J3480,00409707426,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),POTASSIUM CHLORIDE INJ 10 MEQ/100ML,1,99.00, 94.05 ,97.02, 94.05 , 96.03 , 94.05 ,Current Medicare Rates,96.03,95.04,Included in per diem,94.05,Included in ER Case rate,94.05,94.05, 97.02 ,89.1
Rx00338070948,RX,J3480,00338070948,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),POTASSIUM CHLORIDE INJ 10 MEQ/100ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx43825010201,RX,J0131,43825010201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAMINOPHEN IV SOLN 10 MG/ML,1,20.67, 19.64 ,20.26, 19.64 , 20.05 , 19.64 ,Current Medicare Rates,20.05,19.84,Included in per diem,19.64,Included in ER Case rate,19.64,19.64, 20.26 ,18.603
Rx00781315695,RX,J0131,00781315695,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAMINOPHEN IV SOLN 10 MG/ML,1,23.53, 22.35 ,23.06, 22.35 , 22.82 , 22.35 ,Current Medicare Rates,22.82,22.59,Included in per diem,22.35,Included in ER Case rate,22.35,22.35, 23.06 ,21.177
Rx00781315606,RX,J0131,00781315606,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAMINOPHEN IV SOLN 10 MG/ML,1,28.31, 26.89 ,27.74, 26.89 , 27.46 , 26.89 ,Current Medicare Rates,27.46,27.18,Included in per diem,26.89,Included in ER Case rate,26.89,26.89, 27.74 ,25.479
Rx00781927406,RX,J0131,00781927406,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAMINOPHEN IV SOLN 10 MG/ML,1,85.56, 81.28 ,83.85, 81.28 , 82.99 , 81.28 ,Current Medicare Rates,82.99,82.14,Included in per diem,81.28,Included in ER Case rate,81.28,81.28, 83.85 ,77.004
Rx61553016644,RX,J1170,61553016644,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%",1,70.18, 66.67 ,68.78, 66.67 , 68.07 , 66.67 ,Current Medicare Rates,68.07,67.37,Included in per diem,66.67,Included in ER Case rate,66.67,66.67, 68.78 ,63.162
Rx52533000648,RX,J1170,52533000648,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx71449001832,RX,J1170,71449001832,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"HYDROMORPHONE 1 MG/ML PCA/INFUSION,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 50 MG/50ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 30 MG/30ML-0.9%,HYDROMORPHONE HCL-SODIUM CHLORIDE 0.9% IV SOLN 30 MG/30ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 50 MG/50ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 55 MG/55ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 15 MG/15ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 25 MG/25ML-0.9%,HYDROMORPHONE HCL-NACL INJ SOLN PREF SYR 30 MG/30ML-0.9%",1,68.45, 65.03 ,67.08, 65.03 , 66.40 , 65.03 ,Current Medicare Rates,66.4,65.71,Included in per diem,65.03,Included in ER Case rate,65.03,65.03, 67.08 ,61.605
Rx67457052433,RX,J1740,67457052433,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IBANDRONATE SODIUM IV SOLN 3 MG/3ML (BASE EQUIVALENT),1,162.30, 154.19 ,159.05, 154.19 , 157.43 , 154.19 ,Current Medicare Rates,157.43,155.81,Included in per diem,154.19,Included in ER Case rate,154.19,154.19, 159.05 ,146.07
Rx51144005001,RX,J9042,51144005001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BRENTUXIMAB VEDOTIN FOR IV SOLN 50 MG,1,"15,095.58"," 14,340.80 ",14793.67," 14,340.80 "," 14,642.71 "," 14,340.80 ",Current Medicare Rates,14642.71,14491.76,Included in per diem,14340.8,Included in ER Case rate,14340.8,14340.8," 14,793.67 ",13586.022
Rx25021082682,RX,J3489,25021082682,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ZOLEDRONIC ACID IV SOLN 4 MG/100ML,1,121.95, 115.85 ,119.51, 115.85 , 118.29 , 115.85 ,Current Medicare Rates,118.29,117.07,Included in per diem,115.85,Included in ER Case rate,115.85,115.85, 119.51 ,109.755
Rx65250026620,RX,C9290,65250026620,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML),1,79.76, 75.77 ,78.16, 75.77 , 77.37 , 75.77 ,Current Medicare Rates,77.37,76.57,Included in per diem,75.77,Included in ER Case rate,75.77,75.77, 78.16 ,71.784
Rx65250026609,RX,C9290,65250026609,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML),1,79.76, 75.77 ,78.16, 75.77 , 77.37 , 75.77 ,Current Medicare Rates,77.37,76.57,Included in per diem,75.77,Included in ER Case rate,75.77,75.77, 78.16 ,71.784
Rx65250026604,RX,C9290,65250026604,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUPIVACAINE LIPOSOME INJ 1.3% (13.3 MG/ML),1,79.76, 75.77 ,78.16, 75.77 , 77.37 , 75.77 ,Current Medicare Rates,77.37,76.57,Included in per diem,75.77,Included in ER Case rate,75.77,75.77, 78.16 ,71.784
Rx00409018101,RX,J9201,00409018101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GEMCITABINE HCL INJ 1 GM/26.3ML (38 MG/ML) (BASE EQUIV),1,198.48, 188.56 ,194.51, 188.56 , 192.53 , 188.56 ,Current Medicare Rates,192.53,190.54,Included in per diem,188.56,Included in ER Case rate,188.56,188.56, 194.51 ,178.632
Rx00409018201,RX,J9201,00409018201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GEMCITABINE HCL INJ 2 GM/52.6ML (38 MG/ML) (BASE EQUIV),1,240.72, 228.68 ,235.91, 228.68 , 233.50 , 228.68 ,Current Medicare Rates,233.5,231.09,Included in per diem,228.68,Included in ER Case rate,228.68,228.68, 235.91 ,216.648
Rx39822019001,RX,J1120,39822019001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAZOLAMIDE SODIUM FOR INJ 500 MG,1,99.91, 94.91 ,97.91, 94.91 , 96.91 , 94.91 ,Current Medicare Rates,96.91,95.91,Included in per diem,94.91,Included in ER Case rate,94.91,94.91, 97.91 ,89.919
Rx39822019109,RX,J1120,39822019109,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAZOLAMIDE SODIUM FOR INJ 500 MG,1,89.31, 84.84 ,87.52, 84.84 , 86.63 , 84.84 ,Current Medicare Rates,86.63,85.74,Included in per diem,84.84,Included in ER Case rate,84.84,84.84, 87.52 ,80.379
Rx00143950301,RX,J1120,00143950301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAZOLAMIDE SODIUM FOR INJ 500 MG,1,52.46, 49.84 ,51.41, 49.84 , 50.89 , 49.84 ,Current Medicare Rates,50.89,50.36,Included in per diem,49.84,Included in ER Case rate,49.84,49.84, 51.41 ,47.214
Rx67457085350,RX,J1120,67457085350,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAZOLAMIDE SODIUM FOR INJ 500 MG,1,85.63, 81.35 ,83.92, 81.35 , 83.06 , 81.35 ,Current Medicare Rates,83.06,82.2,Included in per diem,81.35,Included in ER Case rate,81.35,81.35, 83.92 ,77.067
Rx00641092825,RX,J2550,00641092825,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROMETHAZINE HCL INJ 25 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323066501,RX,J3105,63323066501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TERBUTALINE SULFATE INJ 1 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx49281021515,RX,90714,49281021515,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LFU,1,104.70, 99.47 ,102.61, 99.47 , 101.56 , 99.47 ,Current Medicare Rates,101.56,100.51,Included in per diem,99.47,Included in ER Case rate,99.47,99.47, 102.61 ,94.23
Rx49281021588,RX,90714,49281021588,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TETANUS-DIPHTHERIA TOXOIDS (TD) INJ 5-2 LFU,1,105.02, 99.77 ,102.92, 99.77 , 101.87 , 99.77 ,Current Medicare Rates,101.87,100.82,Included in per diem,99.77,Included in ER Case rate,99.77,99.77, 102.92 ,94.518
Rx65649055204,RX,J2212,65649055204,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLNALTREXONE BROMIDE INJ 8 MG/0.4ML (20 MG/ML),1,442.79, 420.65 ,433.93, 420.65 , 429.51 , 420.65 ,Current Medicare Rates,429.51,425.08,Included in per diem,420.65,Included in ER Case rate,420.65,420.65, 433.93 ,398.511
Rx00264310511,RX,J0690,00264310511,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR IV SOLN 2 GM AND DEXTROSE 3% (50 ML),1,69.49, 66.02 ,68.1, 66.02 , 67.41 , 66.02 ,Current Medicare Rates,67.41,66.71,Included in per diem,66.02,Included in ER Case rate,66.02,66.02, 68.10 ,62.541
Rx00003049420,RX,J3301,00003049420,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TRIAMCINOLONE ACETONIDE INJ SUSP 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx50242014501,RX,J9306,50242014501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PERTUZUMAB SOLN FOR IV INFUSION 420 MG/14ML (30 MG/ML),1,"10,485.02"," 9,960.77 ",10275.32," 9,960.77 "," 10,170.47 "," 9,960.77 ",Current Medicare Rates,10170.47,10065.62,Included in per diem,9960.77,Included in ER Case rate,9960.77,9960.77," 10,275.32 ",9436.518
Rx00703367101,RX,J9260,00703367101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHOTREXATE SODIUM INJ PF 50 MG/2ML (25 MG/ML),1,146.07, 138.77 ,143.15, 138.77 , 141.69 , 138.77 ,Current Medicare Rates,141.69,140.23,Included in per diem,138.77,Included in ER Case rate,138.77,138.77, 143.15 ,131.463
Rx00409189103,RX,J2270,00409189103,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN PF 4 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409189301,RX,J2270,00409189301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN PF 10 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00641612701,RX,J2270,00641612701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN PF 10 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409189001,RX,J2270,00409189001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN PF 2 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409189003,RX,J2270,00409189003,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN PF 2 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409330803,RX,J7608,00409330803,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETYLCYSTEINE INHAL SOLN 20%,1,10.30, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx63323069041,RX,J7608,63323069041,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETYLCYSTEINE INHAL SOLN 20%,1,10.30, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx63323069044,RX,J7608,63323069044,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETYLCYSTEINE INHAL SOLN 20%,1,10.30, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00409330811,RX,J7608,00409330811,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETYLCYSTEINE INHAL SOLN 20%,1,10.30, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx63833038602,RX,J7168,63833038602,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROTHROMBIN COMPLEX CONC HUMAN FOR INJ KIT 500 UNIT,1,"1,905.50"," 1,810.23 ",1867.39," 1,810.23 "," 1,848.34 "," 1,810.23 ",Current Medicare Rates,1848.34,1829.28,Included in per diem,1810.23,Included in ER Case rate,1810.23,1810.23," 1,867.39 ",1714.95
Rx63833039601,RX,J7168,63833039601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROTHROMBIN COMPLEX CONC HUMAN FOR INJ KIT 500 UNIT,1,"1,758.63"," 1,670.70 ",1723.46," 1,670.70 "," 1,705.87 "," 1,670.70 ",Current Medicare Rates,1705.87,1688.28,Included in per diem,1670.7,Included in ER Case rate,1670.7,1670.7," 1,723.46 ",1582.767
Rx76014000233,RX,J2710,76014000233,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NEOSTIGMINE METHYLSULFATE IV SOLN 5 MG/10 ML (0.5 MG/ML),1,21.86, 20.77 ,21.42, 20.77 , 21.20 , 20.77 ,Current Medicare Rates,21.2,20.99,Included in per diem,20.77,Included in ER Case rate,20.77,20.77, 21.42 ,19.674
Rx76014000210,RX,J2710,76014000210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NEOSTIGMINE METHYLSULFATE IV SOLN 5 MG/10 ML (0.5 MG/ML),1,21.86, 20.77 ,21.42, 20.77 , 21.20 , 20.77 ,Current Medicare Rates,21.2,20.99,Included in per diem,20.77,Included in ER Case rate,20.77,20.77, 21.42 ,19.674
Rx63323041310,RX,J2710,63323041310,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NEOSTIGMINE METHYLSULFATE IV SOLN 5 MG/10 ML (0.5 MG/ML),1,27.99, 26.59 ,27.43, 26.59 , 27.15 , 26.59 ,Current Medicare Rates,27.15,26.87,Included in per diem,26.59,Included in ER Case rate,26.59,26.59, 27.43 ,25.191
Rx63323041336,RX,J2710,63323041336,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NEOSTIGMINE METHYLSULFATE IV SOLN 5 MG/10 ML (0.5 MG/ML),1,219.79, 208.80 ,215.39, 208.80 , 213.20 , 208.80 ,Current Medicare Rates,213.2,211,Included in per diem,208.8,Included in ER Case rate,208.8,208.8, 215.39 ,197.811
Rx42023018801,RX,J2710,42023018801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NEOSTIGMINE METHYLSULFATE IV SOLN 5 MG/10 ML (0.5 MG/ML),1,115.03, 109.28 ,112.73, 109.28 , 111.58 , 109.28 ,Current Medicare Rates,111.58,110.43,Included in per diem,109.28,Included in ER Case rate,109.28,109.28, 112.73 ,103.527
Rx00487980101,RX,J7644,00487980101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IPRATROPIUM BROMIDE INHAL SOLN 0.02%,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx63323031119,RX,J0610,63323031119,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CALCIUM GLUCONATE INJ 10%,1,19.52, 18.54 ,19.13, 18.54 , 18.93 , 18.54 ,Current Medicare Rates,18.93,18.74,Included in per diem,18.54,Included in ER Case rate,18.54,18.54, 19.13 ,17.568
Rx63323036001,RX,J0610,63323036001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CALCIUM GLUCONATE INJ 10%,1,40.83, 38.79 ,40.01, 38.79 , 39.61 , 38.79 ,Current Medicare Rates,39.61,39.2,Included in per diem,38.79,Included in ER Case rate,38.79,38.79, 40.01 ,36.747
Rx00517065001,RX,J1439,00517065001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FERRIC CARBOXYMALTOSE IV SOLN 750 MG/15ML (FE EQUIVALENT),1,1660.67," 1,577.64 ",1627.46," 1,577.64 "," 1,610.85 "," 1,577.64 ",Current Medicare Rates,1610.85,1594.24,Included in per diem,1577.64,Included in ER Case rate,1577.64,1577.64," 1,627.46 ",1494.603
Rx00006404741,RX,90680,00006404741,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"ROTAVIRUS VACCINE, LIVE ORAL PENTAVALENT SOLN",1,268.74, 255.30 ,263.37, 255.30 , 260.68 , 255.30 ,Current Medicare Rates,260.68,257.99,Included in per diem,255.3,Included in ER Case rate,255.3,255.3, 263.37 ,241.866
Rx00409277623,RX,J2260,00409277623,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML,1,98.21, 93.30 ,96.25, 93.30 , 95.26 , 93.30 ,Current Medicare Rates,95.26,94.28,Included in per diem,93.3,Included in ER Case rate,93.3,93.3, 96.25 ,88.389
Rx00143971901,RX,J2260,00143971901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MILRINONE LACTATE IN DEXTROSE 5% IV SOLN 20 MG/100ML,1,68.36, 64.94 ,66.99, 64.94 , 66.31 , 64.94 ,Current Medicare Rates,66.31,65.63,Included in per diem,64.94,Included in ER Case rate,64.94,64.94, 66.99 ,61.524
Rx00143971001,RX,J2260,00143971001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT),1,23.67, 22.49 ,23.2, 22.49 , 22.96 , 22.49 ,Current Medicare Rates,22.96,22.72,Included in per diem,22.49,Included in ER Case rate,22.49,22.49, 23.20 ,21.303
Rx00409021210,RX,J2260,00409021210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MILRINONE LACTATE IV SOLN 10 MG/10ML (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143992490,RX,J0690,00143992490,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021010110,RX,J0690,25021010110,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx44567070725,RX,J0690,44567070725,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021010167,RX,J0690,25021010167,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409080511,RX,J0690,00409080511,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx60505614200,RX,J0690,60505614200,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx60505614205,RX,J0690,60505614205,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323023710,RX,J0690,63323023710,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021010299,RX,J0690,25021010299,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR INJ 10 GM,1,27.92, 26.52 ,27.36, 26.52 , 27.08 , 26.52 ,Current Medicare Rates,27.08,26.8,Included in per diem,26.52,Included in ER Case rate,26.52,26.52, 27.36 ,25.128
Rx63020004901,RX,J9041,63020004901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BORTEZOMIB FOR INJ 3.5 MG,1,3388.67," 3,219.24 ",3320.9," 3,219.24 "," 3,287.01 "," 3,219.24 ",Current Medicare Rates,3287.01,3253.12,Included in per diem,3219.24,Included in ER Case rate,3219.24,3219.24," 3,320.90 ",3049.803
Rx50242007001,RX,J9301,50242007001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OBINUTUZUMAB SOLN FOR IV INFUSION 1000 MG/40ML (25 MG/ML),1,14140.91," 13,433.86 ",13858.09," 13,433.86 "," 13,716.68 "," 13,433.86 ",Current Medicare Rates,13716.68,13575.27,Included in per diem,13433.86,Included in ER Case rate,13433.86,13433.86," 13,858.09 ",12726.819
Rx58160097620,RX,90620,58160097620,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE,1,563.69, 535.51 ,552.42, 535.51 , 546.78 , 535.51 ,Current Medicare Rates,546.78,541.14,Included in per diem,535.51,Included in ER Case rate,535.51,535.51, 552.42 ,507.321
Rx58160097602,RX,90620,58160097602,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MENINGOCOCCAL VAC B (RECOMB OMV ADJUV) INJ PREFILLED SYRINGE,1,464.09, 440.89 ,454.81, 440.89 , 450.17 , 440.89 ,Current Medicare Rates,450.17,445.53,Included in per diem,440.89,Included in ER Case rate,440.89,440.89, 454.81 ,417.681
Rx44206053211,RX,J0850,44206053211,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYTOMEGALOVIRUS IMMUNE GLOBULIN (HUMAN) IV INJ,1,2879.49," 2,735.52 ",2821.9," 2,735.52 "," 2,793.11 "," 2,735.52 ",Current Medicare Rates,2793.11,2764.31,Included in per diem,2735.52,Included in ER Case rate,2735.52,2735.52," 2,821.90 ",2591.541
Rx63459091017,RX,J1447,63459091017,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TBO-FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML,1,815.41, 774.64 ,799.1, 774.64 , 790.95 , 774.64 ,Current Medicare Rates,790.95,782.79,Included in per diem,774.64,Included in ER Case rate,774.64,774.64, 799.10 ,733.869
Rx63459091036,RX,J1447,63459091036,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TBO-FILGRASTIM SOLN PREFILLED SYRINGE 300 MCG/0.5ML,1,815.39, 774.62 ,799.08, 774.62 , 790.93 , 774.62 ,Current Medicare Rates,790.93,782.77,Included in per diem,774.62,Included in ER Case rate,774.62,774.62, 799.08 ,733.851
Rx59676032000,RX,J0885,59676032000,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPOETIN ALFA INJ 20000 UNIT/ML,1,1067.44," 1,014.07 ",1046.09," 1,014.07 "," 1,035.42 "," 1,014.07 ",Current Medicare Rates,1035.42,1024.74,Included in per diem,1014.07,Included in ER Case rate,1014.07,1014.07," 1,046.09 ",960.696
Rx16729011431,RX,J9181,16729011431,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ETOPOSIDE INJ 100 MG/5ML (20 MG/ML),1,138.11, 131.20 ,135.35, 131.20 , 133.97 , 131.20 ,Current Medicare Rates,133.97,132.59,Included in per diem,131.2,Included in ER Case rate,131.2,131.2, 135.35 ,124.299
Rx00703565301,RX,J9181,00703565301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ETOPOSIDE INJ 100 MG/5ML (20 MG/ML),1,150.23, 142.72 ,147.23, 142.72 , 145.72 , 142.72 ,Current Medicare Rates,145.72,144.22,Included in per diem,142.72,Included in ER Case rate,142.72,142.72, 147.23 ,135.207
Rx00143951001,RX,J9181,00143951001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ETOPOSIDE INJ 100 MG/5ML (20 MG/ML),1,137.14, 130.28 ,134.4, 130.28 , 133.03 , 130.28 ,Current Medicare Rates,133.03,131.65,Included in per diem,130.28,Included in ER Case rate,130.28,130.28, 134.40 ,123.426
Rx49502010102,RX,J0171,49502010102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000),1,440.71, 418.67 ,431.9, 418.67 , 427.49 , 418.67 ,Current Medicare Rates,427.49,423.08,Included in per diem,418.67,Included in ER Case rate,418.67,418.67, 431.90 ,396.639
Rx49502010101,RX,J0171,49502010101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPINEPHRINE SOLUTION AUTO-INJECTOR 0.15 MG/0.3ML (1:2000),1,442.15, 420.04 ,433.31, 420.04 , 428.89 , 420.04 ,Current Medicare Rates,428.89,424.46,Included in per diem,420.04,Included in ER Case rate,420.04,420.04, 433.31 ,397.935
Rx54505010202,RX,J0171,54505010202,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000),1,505.69, 480.41 ,495.58, 480.41 , 490.52 , 480.41 ,Current Medicare Rates,490.52,485.46,Included in per diem,480.41,Included in ER Case rate,480.41,480.41, 495.58 ,455.121
Rx49502010202,RX,J0171,49502010202,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000),1,440.71, 418.67 ,431.9, 418.67 , 427.49 , 418.67 ,Current Medicare Rates,427.49,423.08,Included in per diem,418.67,Included in ER Case rate,418.67,418.67, 431.90 ,396.639
Rx49502010201,RX,J0171,49502010201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000),1,442.15, 420.04 ,433.31, 420.04 , 428.89 , 420.04 ,Current Medicare Rates,428.89,424.46,Included in per diem,420.04,Included in ER Case rate,420.04,420.04, 433.31 ,397.935
Rx49502050002,RX,J0171,49502050002,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPINEPHRINE SOLUTION AUTO-INJECTOR 0.3 MG/0.3ML (1:1000),1,931.72, 885.13 ,913.09, 885.13 , 903.77 , 885.13 ,Current Medicare Rates,903.77,894.45,Included in per diem,885.13,Included in ER Case rate,885.13,885.13, 913.09 ,838.548
Rx00409780922,RX,J1265,00409780922,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOPAMINE INJ 1.6 MG/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00338100702,RX,J1265,00338100702,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOPAMINE INJ 1.6 MG/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00409780911,RX,J1265,00409780911,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOPAMINE INJ 1.6 MG/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00002766901,RX,J9308,00002766901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RAMUCIRUMAB IV SOLN 100 MG/10ML (FOR INFUSION),1,2627.5," 2,496.13 ",2574.95," 2,496.13 "," 2,548.68 "," 2,496.13 ",Current Medicare Rates,2548.68,2522.4,Included in per diem,2496.13,Included in ER Case rate,2496.13,2496.13," 2,574.95 ",2364.75
Rx00002767801,RX,J9308,00002767801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RAMUCIRUMAB IV SOLN 500 MG/50ML (FOR INFUSION),1,12725.54," 12,089.26 ",12471.03," 12,089.26 "," 12,343.77 "," 12,089.26 ",Current Medicare Rates,12343.77,12216.52,Included in per diem,12089.26,Included in ER Case rate,12089.26,12089.26," 12,471.03 ",11452.986
Rx00264959820,RX,J2001,00264959820,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00338041102,RX,J2001,00338041102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE IV INFUSION IN D5W INJ 8 MG/ML,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx64764030020,RX,J3380,64764030020,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VEDOLIZUMAB FOR IV SOLUTION 300 MG,1,15017.91," 14,267.01 ",14717.55," 14,267.01 "," 14,567.37 "," 14,267.01 ",Current Medicare Rates,14567.37,14417.19,Included in per diem,14267.01,Included in ER Case rate,14267.01,14267.01," 14,717.55 ",13516.119
Rx13533063102,RX,J2790,13533063102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG),1,259.56, 246.58 ,254.37, 246.58 , 251.77 , 246.58 ,Current Medicare Rates,251.77,249.18,Included in per diem,246.58,Included in ER Case rate,246.58,246.58, 254.37 ,233.604
Rx13533063120,RX,J2790,13533063120,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RHO D IMMUNE GLOBULIN IM SOLN PREF SYR 1500 UNIT (300MCG),1,239.55, 227.57 ,234.76, 227.57 , 232.36 , 227.57 ,Current Medicare Rates,232.36,229.97,Included in per diem,227.57,Included in ER Case rate,227.57,227.57, 234.76 ,215.595
Rx19515090952,RX,90686,19515090952,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLUENZA VIRUS VAC SPLIT QUADRIVALENT SUSP PREF SYR 0.5ML,1,72.17, 68.56 ,70.73, 68.56 , 70.00 , 68.56 ,Current Medicare Rates,70,69.28,Included in per diem,68.56,Included in ER Case rate,68.56,68.56, 70.73 ,64.953
Rx19515081641,RX,90686,19515081641,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLUENZA VIRUS VAC SPLIT QUADRIVALENT SUSP PREF SYR 0.5ML,1,64.89, 61.65 ,63.59, 61.65 , 62.94 , 61.65 ,Current Medicare Rates,62.94,62.29,Included in per diem,61.65,Included in ER Case rate,61.65,61.65, 63.59 ,58.401
Rx19515081652,RX,90686,19515081652,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLUENZA VIRUS VAC SPLIT QUADRIVALENT SUSP PREF SYR 0.5ML,1,64.89, 61.65 ,63.59, 61.65 , 62.94 , 61.65 ,Current Medicare Rates,62.94,62.29,Included in per diem,61.65,Included in ER Case rate,61.65,61.65, 63.59 ,58.401
Rx59676036001,RX,J7324,59676036001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYALURONAN INTRA-ARTICULAR SOLN PREFILLED SYRINGE 30 MG/2ML,1,841.5, 799.43 ,824.67, 799.43 , 816.26 , 799.43 ,Current Medicare Rates,816.26,807.84,Included in per diem,799.43,Included in ER Case rate,799.43,799.43, 824.67 ,757.35
Rx55566410001,RX,J7323,55566410001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SODIUM HYALURONATE INTRA-ARTICULAR SOLN PREF SYR 20 MG/2ML,1,1051.3, 998.74 ,1030.27, 998.74 ," 1,019.76 ", 998.74 ,Current Medicare Rates,1019.76,1009.25,Included in per diem,998.74,Included in ER Case rate,998.74,998.74," 1,030.27 ",946.17
Rx68982085004,RX,J1568,68982085004,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IMMUNE GLOBULIN (HUMAN) IV SOLN 20 GM/200ML,1,3313.66," 3,147.98 ",3247.39," 3,147.98 "," 3,214.25 "," 3,147.98 ",Current Medicare Rates,3214.25,3181.11,Included in per diem,3147.98,Included in ER Case rate,3147.98,3147.98," 3,247.39 ",2982.294
Rx00641614225,RX,J2370,00641614225,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHENYLEPHRINE HCL IV SOLN 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641614201,RX,J2370,00641614201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHENYLEPHRINE HCL IV SOLN 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00006412102,RX,90651,00006412102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HUMAN PAPILLOMAVIRUS (HPV) 9-VALENT RECOMB VAC SUSP PREF SYR,1,761.05, 723.00 ,745.83, 723.00 , 738.22 , 723.00 ,Current Medicare Rates,738.22,730.61,Included in per diem,723,Included in ER Case rate,723,723, 745.83 ,684.945
Rx00003377412,RX,J9299,00003377412,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NIVOLUMAB IV SOLN 100 MG/10ML,1,5807.28," 5,516.92 ",5691.13," 5,516.92 "," 5,633.06 "," 5,516.92 ",Current Medicare Rates,5633.06,5574.99,Included in per diem,5516.92,Included in ER Case rate,5516.92,5516.92," 5,691.13 ",5226.552
Rx13533063504,RX,J1460,13533063504,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IMMUNE GLOBULIN (HUMAN) IM INJ,1,346.31, 328.99 ,339.38, 328.99 , 335.92 , 328.99 ,Current Medicare Rates,335.92,332.46,Included in per diem,328.99,Included in ER Case rate,328.99,328.99, 339.38 ,311.679
Rx61314031801,RX,Q5101,61314031801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FILGRASTIM-SNDZ SOLN PREFILLED SYRINGE 300 MCG/0.5ML,1,443.4, 421.23 ,434.53, 421.23 , 430.10 , 421.23 ,Current Medicare Rates,430.1,425.66,Included in per diem,421.23,Included in ER Case rate,421.23,421.23, 434.53 ,399.06
Rx50242005121,RX,J9312,50242005121,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RITUXIMAB IV SOLN 100 MG/10ML,1,2028.72," 1,927.28 ",1988.15," 1,927.28 "," 1,967.86 "," 1,927.28 ",Current Medicare Rates,1967.86,1947.57,Included in per diem,1927.28,Included in ER Case rate,1927.28,1927.28," 1,988.15 ",1825.848
Rx50242005306,RX,J9312,50242005306,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RITUXIMAB IV SOLN 500 MG/50ML,1,9731.64," 9,245.06 ",9537.01," 9,245.06 "," 9,439.69 "," 9,245.06 ",Current Medicare Rates,9439.69,9342.37,Included in per diem,9245.06,Included in ER Case rate,9245.06,9245.06," 9,537.01 ",8758.476
Rx00409672903,RX,J3475,00409672903,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IV SOLN 20 GM/500ML (40 MG/ML),1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx55513019001,RX,J2506,55513019001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PEGFILGRASTIM SOLN PREFILLED SYRINGE 6 MG/0.6ML,1,6751.72," 6,414.13 ",6616.69," 6,414.13 "," 6,549.17 "," 6,414.13 ",Current Medicare Rates,6549.17,6481.65,Included in per diem,6414.13,Included in ER Case rate,6414.13,6414.13," 6,616.69 ",6076.548
Rx55513002301,RX,J0881,55513002301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 60 MCG/0.3ML,1,1276.89," 1,213.05 ",1251.35," 1,213.05 "," 1,238.58 "," 1,213.05 ",Current Medicare Rates,1238.58,1225.81,Included in per diem,1213.05,Included in ER Case rate,1213.05,1213.05," 1,251.35 ",1149.201
Rx55513002501,RX,J0881,55513002501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 100 MCG/0.5ML,1,1773.46," 1,684.79 ",1737.99," 1,684.79 "," 1,720.26 "," 1,684.79 ",Current Medicare Rates,1720.26,1702.52,Included in per diem,1684.79,Included in ER Case rate,1684.79,1684.79," 1,737.99 ",1596.114
Rx55513002701,RX,J0881,55513002701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 150 MCG/0.3ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx55513002704,RX,J0881,55513002704,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 150 MCG/0.3ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx55513002801,RX,J0881,55513002801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DARBEPOETIN ALFA SOLN PREFILLED SYRINGE 200 MCG/0.4ML,1,3535.44," 3,358.67 ",3464.73," 3,358.67 "," 3,429.38 "," 3,358.67 ",Current Medicare Rates,3429.38,3394.02,Included in per diem,3358.67,Included in ER Case rate,3358.67,3358.67," 3,464.73 ",3181.896
Rx59676061001,RX,J9352,59676061001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TRABECTEDIN FOR INJ 1 MG,1,5872.35," 5,578.73 ",5754.9," 5,578.73 "," 5,696.18 "," 5,578.73 ",Current Medicare Rates,5696.18,5637.46,Included in per diem,5578.73,Included in ER Case rate,5578.73,5578.73," 5,754.90 ",5285.115
Rx00597019705,RX,J3590,00597019705,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IDARUCIZUMAB IV SOLN 2.5 GM/50ML,1,8113.42," 7,707.75 ",7951.15," 7,707.75 "," 7,870.02 "," 7,707.75 ",Current Medicare Rates,7870.02,7788.88,Included in per diem,7707.75,Included in ER Case rate,7707.75,7707.75," 7,951.15 ",7302.078
Rx57894050220,RX,J9145,57894050220,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DARATUMUMAB IV SOLN 400 MG/20ML,1,4853.68," 4,611.00 ",4756.61," 4,611.00 "," 4,708.07 "," 4,611.00 ",Current Medicare Rates,4708.07,4659.53,Included in per diem,4611,Included in ER Case rate,4611,4611," 4,756.61 ",4368.312
Rx63459034804,RX,J9034,63459034804,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BENDAMUSTINE HCL IV SOLN 100 MG/4ML (25 MG/ML),1,3304.59," 3,139.36 ",3238.5," 3,139.36 "," 3,205.45 "," 3,139.36 ",Current Medicare Rates,3205.45,3172.41,Included in per diem,3139.36,Included in ER Case rate,3139.36,3139.36," 3,238.50 ",2974.131
Rx00338102541,RX,J2540,00338102541,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PENICILLIN G POTASSIUM INJ 60000 UNIT/ML IN DEXTROSE,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00338107702,RX,J1250,00338107702,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOBUTAMINE INJ 4 MG/ML IN D5W,1,55.87, 53.08 ,54.75, 53.08 , 54.19 , 53.08 ,Current Medicare Rates,54.19,53.64,Included in per diem,53.08,Included in ER Case rate,53.08,53.08, 54.75 ,50.283
Rx00009514001,RX,J2020,00009514001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),1,104.57, 99.34 ,102.48, 99.34 , 101.43 , 99.34 ,Current Medicare Rates,101.43,100.39,Included in per diem,99.34,Included in ER Case rate,99.34,99.34, 102.48 ,94.113
Rx00781343346,RX,J2020,00781343346,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),1,167.68, 159.30 ,164.33, 159.30 , 162.65 , 159.30 ,Current Medicare Rates,162.65,160.97,Included in per diem,159.3,Included in ER Case rate,159.3,159.3, 164.33 ,150.912
Rx00781343395,RX,J2020,00781343395,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),1,86.95, 82.60 ,85.21, 82.60 , 84.34 , 82.60 ,Current Medicare Rates,84.34,83.47,Included in per diem,82.6,Included in ER Case rate,82.6,82.6, 85.21 ,78.255
Rx63323026929,RX,J2704,63323026929,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00641602701,RX,J3010,00641602701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00409909425,RX,J3010,00409909425,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409909418,RX,J3010,00409909418,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx63323080605,RX,J3010,63323080605,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx63323080613,RX,J3010,63323080613,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx55150021910,RX,J1327,55150021910,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML),1,117.87, 111.98 ,115.51, 111.98 , 114.33 , 111.98 ,Current Medicare Rates,114.33,113.16,Included in per diem,111.98,Included in ER Case rate,111.98,111.98, 115.51 ,106.083
Rx25021040910,RX,J1327,25021040910,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML),1,123.1, 116.95 ,120.64, 116.95 , 119.41 , 116.95 ,Current Medicare Rates,119.41,118.18,Included in per diem,116.95,Included in ER Case rate,116.95,116.95, 120.64 ,110.79
Rx00085117701,RX,J1327,00085117701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPTIFIBATIDE IV SOLN 20 MG/10ML (2 MG/ML),1,564.58, 536.35 ,553.29, 536.35 , 547.64 , 536.35 ,Current Medicare Rates,547.64,542,Included in per diem,536.35,Included in ER Case rate,536.35,536.35, 553.29 ,508.122
Rx50242091701,RX,J9022,50242091701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ATEZOLIZUMAB IV SOLN 1200 MG/20ML,1,19513.35," 18,537.68 ",19123.08," 18,537.68 "," 18,927.95 "," 18,537.68 ",Current Medicare Rates,18927.95,18732.82,Included in per diem,18537.68,Included in ER Case rate,18537.68,18537.68," 19,123.08 ",17562.015
Rx25021012120,RX,J0692,25021012120,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFEPIME HCL FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021012166,RX,J0692,25021012166,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFEPIME HCL FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021012250,RX,J0692,25021012250,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFEPIME HCL FOR INJ 2 GM,1,41.71, 39.62 ,40.88, 39.62 , 40.46 , 39.62 ,Current Medicare Rates,40.46,40.04,Included in per diem,39.62,Included in ER Case rate,39.62,39.62, 40.88 ,37.539
Rx63323034020,RX,J0692,63323034020,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFEPIME HCL FOR INJ 2 GM,1,42.34, 40.22 ,41.49, 40.22 , 41.07 , 40.22 ,Current Medicare Rates,41.07,40.65,Included in per diem,40.22,Included in ER Case rate,40.22,40.22, 41.49 ,38.106
Rx25021012267,RX,J0692,25021012267,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFEPIME HCL FOR INJ 2 GM,1,33.96, 32.26 ,33.28, 32.26 , 32.94 , 32.26 ,Current Medicare Rates,32.94,32.6,Included in per diem,32.26,Included in ER Case rate,32.26,32.26, 33.28 ,30.564
Rx63323034021,RX,J0692,63323034021,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFEPIME HCL FOR INJ 2 GM,1,42.48, 40.36 ,41.63, 40.36 , 41.21 , 40.36 ,Current Medicare Rates,41.21,40.78,Included in per diem,40.36,Included in ER Case rate,40.36,40.36, 41.63 ,38.232
Rx76075010201,RX,J9047,76075010201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARFILZOMIB FOR INJ 30 MG,1,1982.2," 1,883.09 ",1942.56," 1,883.09 "," 1,922.73 "," 1,883.09 ",Current Medicare Rates,1922.73,1902.91,Included in per diem,1883.09,Included in ER Case rate,1883.09,1883.09," 1,942.56 ",1783.98
Rx00517037401,RX,Q9968,00517037401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLENE BLUE IV SOLN 50 MG/10ML (5 MG/ML),1,679.5, 645.53 ,665.91, 645.53 , 659.12 , 645.53 ,Current Medicare Rates,659.12,652.32,Included in per diem,645.53,Included in ER Case rate,645.53,645.53, 665.91 ,611.55
Rx76329336901,RX,J2310,76329336901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NALOXONE HCL SOLN PREFILLED SYRINGE 2 MG/2ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx57894005427,RX,J3358,57894005427,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),USTEKINUMAB IV SOLN 130 MG/26ML (5 MG/ML) (FOR IV INFUSION),1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00006302500,RX,J0565,00006302500,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BEZLOTOXUMAB IV SOLN 1000 MG/40ML (25 MG/ML),1,6425.74," 6,104.45 ",6297.23," 6,104.45 "," 6,232.97 "," 6,104.45 ",Current Medicare Rates,6232.97,6168.71,Included in per diem,6104.45,Included in ER Case rate,6104.45,6104.45," 6,297.23 ",5783.166
Rx61553065644,RX,J2270,61553065644,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%,1,69.91, 66.41 ,68.51, 66.41 , 67.81 , 66.41 ,Current Medicare Rates,67.81,67.11,Included in per diem,66.41,Included in ER Case rate,66.41,66.41, 68.51 ,62.919
Rx71449002232,RX,J2270,71449002232,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE-NACL SOLN PREF SYR 150 MG/30ML-0.9%,1,69.91, 66.41 ,68.51, 66.41 , 67.81 , 66.41 ,Current Medicare Rates,67.81,67.11,Included in per diem,66.41,Included in ER Case rate,66.41,66.41, 68.51 ,62.919
Rx00409672723,RX,J3475,00409672723,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx63323010801,RX,J3475,63323010801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx63323010800,RX,J3475,63323010800,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IN DEXTROSE 5% IV SOLN 1 GM/100ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00641600601,RX,J0461,00641600601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML),1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx63323058003,RX,J0461,63323058003,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ATROPINE SULFATE INJ 8 MG/20ML (0.4 MG/ML),1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx50242015001,RX,J2350,50242015001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OCRELIZUMAB SOLN FOR IV INFUSION 300 MG/10ML,1,28303.15," 26,887.99 ",27737.09," 26,887.99 "," 27,454.06 "," 26,887.99 ",Current Medicare Rates,27454.06,27171.02,Included in per diem,26887.99,Included in ER Case rate,26887.99,26887.99," 27,737.09 ",25472.835
Rx63323013720,RX,J9040,63323013720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BLEOMYCIN SULFATE FOR INJ 30 UNIT,1,231.95, 220.35 ,227.31, 220.35 , 224.99 , 220.35 ,Current Medicare Rates,224.99,222.67,Included in per diem,220.35,Included in ER Case rate,220.35,220.35, 227.31 ,208.755
Rx50242010901,RX,J9311,50242010901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RITUXIMAB-HYALURONIDASE HUMAN INJ 1600-26800 MG-UNIT/13.4ML,1,12709.73," 12,074.24 ",12455.54," 12,074.24 "," 12,328.44 "," 12,074.24 ",Current Medicare Rates,12328.44,12201.34,Included in per diem,12074.24,Included in ER Case rate,12074.24,12074.24," 12,455.54 ",11438.757
Rx00006430502,RX,Q5104,00006430502,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLIXIMAB-ABDA FOR IV INJ 100 MG,1,1009.97, 959.47 ,989.77, 959.47 , 979.67 , 959.47 ,Current Medicare Rates,979.67,969.57,Included in per diem,959.47,Included in ER Case rate,959.47,959.47, 989.77 ,908.973
Rx78206016201,RX,Q5104,78206016201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLIXIMAB-ABDA FOR IV INJ 100 MG,1,1007.03, 956.68 ,986.89, 956.68 , 976.82 , 956.68 ,Current Medicare Rates,976.82,966.75,Included in per diem,956.68,Included in ER Case rate,956.68,956.68, 986.89 ,906.327
Rx49281072010,RX,90682,49281072010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLUENZA VAC RECOMB HA QUAD PF SOLN PREF SYR 0.5 ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx49281072088,RX,90682,49281072088,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLUENZA VAC RECOMB HA QUAD PF SOLN PREF SYR 0.5 ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx58160082311,RX,90750,58160082311,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ZOSTER VAC RECOMBINANT ADJUVANTED FOR IM INJ 50 MCG/0.5ML,1,500.56, 475.53 ,490.55, 475.53 , 485.54 , 475.53 ,Current Medicare Rates,485.54,480.54,Included in per diem,475.53,Included in ER Case rate,475.53,475.53, 490.55 ,450.504
Rx00003373413,RX,J9299,00003373413,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NIVOLUMAB IV SOLN 240 MG/24ML,1,13793.28," 13,103.62 ",13517.41," 13,103.62 "," 13,379.48 "," 13,103.62 ",Current Medicare Rates,13379.48,13241.55,Included in per diem,13103.62,Included in ER Case rate,13103.62,13103.62," 13,517.41 ",12413.952
Rx63323050720,RX,J2185,63323050720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEROPENEM IV FOR SOLN 500 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781300095,RX,J2185,00781300095,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEROPENEM IV FOR SOLN 500 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150020720,RX,J2185,55150020720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEROPENEM IV FOR SOLN 500 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781300094,RX,J2185,00781300094,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEROPENEM IV FOR SOLN 500 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323050830,RX,J2185,63323050830,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEROPENEM IV FOR SOLN 1 GM,1,24.79, 23.55 ,24.29, 23.55 , 24.05 , 23.55 ,Current Medicare Rates,24.05,23.8,Included in per diem,23.55,Included in ER Case rate,23.55,23.55, 24.29 ,22.311
Rx63323050801,RX,J2185,63323050801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEROPENEM IV FOR SOLN 1 GM,1,24.77, 23.53 ,24.27, 23.53 , 24.03 , 23.53 ,Current Medicare Rates,24.03,23.78,Included in per diem,23.53,Included in ER Case rate,23.53,23.53, 24.27 ,22.293
Rx00069130901,RX,Q5106,00069130901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPOETIN ALFA-EPBX INJ 40000 UNIT/ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00069130904,RX,Q5106,00069130904,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPOETIN ALFA-EPBX INJ 40000 UNIT/ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx76075010301,RX,J9047,76075010301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARFILZOMIB FOR INJ 10 MG,1,983.97, 934.77 ,964.29, 934.77 , 954.45 , 934.77 ,Current Medicare Rates,954.45,944.61,Included in per diem,934.77,Included in ER Case rate,934.77,934.77, 964.29 ,885.573
Rx70860010520,RX,J3370,70860010520,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx47781059791,RX,J3370,47781059791,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),1,23.63, 22.45 ,23.16, 22.45 , 22.92 , 22.45 ,Current Medicare Rates,22.92,22.68,Included in per diem,22.45,Included in ER Case rate,22.45,22.45, 23.16 ,21.267
Rx47781059707,RX,J3370,47781059707,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),1,23.63, 22.45 ,23.16, 22.45 , 22.92 , 22.45 ,Current Medicare Rates,22.92,22.68,Included in per diem,22.45,Included in ER Case rate,22.45,22.45, 23.16 ,21.267
Rx63323028420,RX,J3370,63323028420,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 1 GM (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx50242021501,RX,J2357,50242021501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 150 MG/ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx50242021401,RX,J2357,50242021401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE 75 MG/0.5ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx70114010101,RX,Q5111,70114010101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PEGFILGRASTIM-CBQV SOLN PREFILLED SYRINGE 6 MG/0.6ML,1,3338.49," 3,171.57 ",3271.72," 3,171.57 "," 3,238.34 "," 3,171.57 ",Current Medicare Rates,3238.34,3204.95,Included in per diem,3171.57,Included in ER Case rate,3171.57,3171.57," 3,271.72 ",3004.641
Rx00054317644,RX,J8540,00054317644,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE CONC 1 MG/ML,1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx23155029431,RX,J0780,23155029431,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROCHLORPERAZINE EDISYLATE INJ 10 MG/2ML,1,18.8, 17.86 ,18.42, 17.86 , 18.24 , 17.86 ,Current Medicare Rates,18.24,18.05,Included in per diem,17.86,Included in ER Case rate,17.86,17.86, 18.42 ,16.92
Rx55513071001,RX,J0897,55513071001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DENOSUMAB INJ SOLN PREFILLED SYRINGE 60 MG/ML,1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx70594004201,RX,J3370,70594004201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL IV SOLN 1000 MG/200ML (BASE EQUIVALENT),1,42.53, 40.40 ,41.68, 40.40 , 41.25 , 40.40 ,Current Medicare Rates,41.25,40.83,Included in per diem,40.4,Included in ER Case rate,40.4,40.4, 41.68 ,38.277
Rx70594004203,RX,J3370,70594004203,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL IV SOLN 1000 MG/200ML (BASE EQUIVALENT),1,42.53, 40.40 ,41.68, 40.40 , 41.25 , 40.40 ,Current Medicare Rates,41.25,40.83,Included in per diem,40.4,Included in ER Case rate,40.4,40.4, 41.68 ,38.277
Rx50242091801,RX,J9022,50242091801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ATEZOLIZUMAB IV SOLN 840 MG/14ML,1,11209.47," 10,649.00 ",10985.28," 10,649.00 "," 10,873.19 "," 10,649.00 ",Current Medicare Rates,10873.19,10761.09,Included in per diem,10649,Included in ER Case rate,10649,10649," 10,985.28 ",10088.523
Rx00173089242,RX,J2182,00173089242,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEPOLIZUMAB SUBCUTANEOUS SOLUTION PREF SYRINGE 100 MG/ML,1,5561.5," 5,283.43 ",5450.27," 5,283.43 "," 5,394.66 "," 5,283.43 ",Current Medicare Rates,5394.66,5339.04,Included in per diem,5283.43,Included in ER Case rate,5283.43,5283.43," 5,450.27 ",5005.35
Rx00409930220,RX,J2795,00409930220,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ROPIVACAINE HCL INJ 7.5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323028631,RX,J2795,63323028631,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ROPIVACAINE HCL INJ 5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150019830,RX,J2795,55150019830,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ROPIVACAINE HCL INJ 5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409339004,RX,J2543,00409339004,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM),1,35.05, 33.30 ,34.35, 33.30 , 34.00 , 33.30 ,Current Medicare Rates,34,33.65,Included in per diem,33.3,Included in ER Case rate,33.3,33.3, 34.35 ,31.545
Rx00781311491,RX,J2543,00781311491,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM),1,20.7, 19.67 ,20.29, 19.67 , 20.08 , 19.67 ,Current Medicare Rates,20.08,19.87,Included in per diem,19.67,Included in ER Case rate,19.67,19.67, 20.29 ,18.63
Rx55150012150,RX,J2543,55150012150,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323032056,RX,J2543,63323032056,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 4.5 GM (4-0.5 GM),1,75.75, 71.96 ,74.24, 71.96 , 73.48 , 71.96 ,Current Medicare Rates,73.48,72.72,Included in per diem,71.96,Included in ER Case rate,71.96,71.96, 74.24 ,68.175
Rx00206885416,RX,J2543,00206885416,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),1,39.28, 37.32 ,38.49, 37.32 , 38.10 , 37.32 ,Current Medicare Rates,38.1,37.71,Included in per diem,37.32,Included in ER Case rate,37.32,37.32, 38.49 ,35.352
Rx55150012030,RX,J2543,55150012030,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx60505615700,RX,J2543,60505615700,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx60505615704,RX,J2543,60505615704,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx70860012130,RX,J2543,70860012130,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx70860012141,RX,J2543,70860012141,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM NA FOR INJ 3.375 GM (3-0.375 GM),1,26.35, 25.03 ,25.82, 25.03 , 25.56 , 25.03 ,Current Medicare Rates,25.56,25.3,Included in per diem,25.03,Included in ER Case rate,25.03,25.03, 25.82 ,23.715
Rx00409338302,RX,J2543,00409338302,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,25.2, 23.94 ,24.7, 23.94 , 24.44 , 23.94 ,Current Medicare Rates,24.44,24.19,Included in per diem,23.94,Included in ER Case rate,23.94,23.94, 24.70 ,22.68
Rx00781311090,RX,J2543,00781311090,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323030920,RX,J2543,63323030920,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,39.92, 37.92 ,39.12, 37.92 , 38.72 , 37.92 ,Current Medicare Rates,38.72,38.32,Included in per diem,37.92,Included in ER Case rate,37.92,37.92, 39.12 ,35.928
Rx55150011930,RX,J2543,55150011930,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx64679003401,RX,J2543,64679003401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx64679003402,RX,J2543,64679003402,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx61990011001,RX,J2543,61990011001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx61990011002,RX,J2543,61990011002,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN SOD-TAZOBACTAM SOD FOR INJ 2.25 GM (2-0.25 GM),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457084744,RX,Q5114,67457084744,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TRASTUZUMAB-DKST FOR IV SOLN 420 MG,1,2824.63," 2,683.40 ",2768.14," 2,683.40 "," 2,739.89 "," 2,683.40 ",Current Medicare Rates,2739.89,2711.64,Included in per diem,2683.4,Included in ER Case rate,2683.4,2683.4," 2,768.14 ",2542.167
Rx70594004101,RX,J3370,70594004101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL IV SOLN 500 MG/100ML (BASE EQUIVALENT),1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx70594004103,RX,J3370,70594004103,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL IV SOLN 500 MG/100ML (BASE EQUIVALENT),1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx67457099115,RX,Q5114,67457099115,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TRASTUZUMAB-DKST FOR IV SOLN 150 MG,1,1073.65," 1,019.97 ",1052.18," 1,019.97 "," 1,041.44 "," 1,019.97 ",Current Medicare Rates,1041.44,1030.7,Included in per diem,1019.97,Included in ER Case rate,1019.97,1019.97," 1,052.18 ",966.285
Rx65597040601,RX,J9358,65597040601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FAM-TRASTUZUMAB DERUXTECAN-NXKI FOR IV SOLN 100 MG,1,4951.29," 4,703.73 ",4852.26," 4,703.73 "," 4,802.75 "," 4,703.73 ",Current Medicare Rates,4802.75,4753.24,Included in per diem,4703.73,Included in ER Case rate,4703.73,4703.73," 4,852.26 ",4456.161
Rx00069024901,RX,Q5119,00069024901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),RITUXIMAB-PVVR IV SOLN 500 MG/50ML (10 MG/ML),1,5602.27," 5,322.16 ",5490.22," 5,322.16 "," 5,434.20 "," 5,322.16 ",Current Medicare Rates,5434.2,5378.18,Included in per diem,5322.16,Included in ER Case rate,5322.16,5322.16," 5,490.22 ",5042.043
Rx61958290101,RX,J3490,61958290101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),REMDESIVIR FOR IV SOLN 100 MG,1,990.86, 941.32 ,971.04, 941.32 , 961.13 , 941.32 ,Current Medicare Rates,961.13,951.23,Included in per diem,941.32,Included in ER Case rate,941.32,941.32, 971.04 ,891.774
Rx57894050301,RX,J9144,57894050301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DARATUMUMAB-HYALURONIDASE-FIHJ INJ 1800-30000 MG-UNIT/15ML,1,16291.23," 15,476.67 ",15965.41," 15,476.67 "," 15,802.49 "," 15,476.67 ",Current Medicare Rates,15802.49,15639.58,Included in per diem,15476.67,Included in ER Case rate,15476.67,15476.67," 15,965.41 ",14662.107
Rx55513067001,RX,Q5121,55513067001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLIXIMAB-AXXQ FOR IV INJ 100 MG,1,845.03, 802.78 ,828.13, 802.78 , 819.68 , 802.78 ,Current Medicare Rates,819.68,811.23,Included in per diem,802.78,Included in ER Case rate,802.78,802.78, 828.13 ,760.527
Rx68727071201,RX,J9223,68727071201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LURBINECTEDIN FOR IV SOLN 4 MG,1,14242.48," 13,530.36 ",13957.63," 13,530.36 "," 13,815.21 "," 13,530.36 ",Current Medicare Rates,13815.21,13672.78,Included in per diem,13530.36,Included in ER Case rate,13530.36,13530.36," 13,957.63 ",12818.232
Rx70594005601,RX,J3370,70594005601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL IV SOLN 750 MG/150ML (BASE EQUIVALENT),1,31.9, 30.31 ,31.26, 30.31 , 30.94 , 30.31 ,Current Medicare Rates,30.94,30.62,Included in per diem,30.31,Included in ER Case rate,30.31,30.31, 31.26 ,28.71
Rx70594005603,RX,J3370,70594005603,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL IV SOLN 750 MG/150ML (BASE EQUIVALENT),1,31.9, 30.31 ,31.26, 30.31 , 30.94 , 30.31 ,Current Medicare Rates,30.94,30.62,Included in per diem,30.31,Included in ER Case rate,30.31,30.31, 31.26 ,28.71
Rx51672409103,RX,Q0162,51672409103,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL ORAL SOLN 4 MG/5ML,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,Included in per diem,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
Rx65162069179,RX,Q0162,65162069179,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL ORAL SOLN 4 MG/5ML,1,6.62, 6.29 ,6.49, 6.29 , 6.42 , 6.29 ,Current Medicare Rates,6.42,6.36,Included in per diem,6.29,Included in ER Case rate,6.29,6.29, 6.49 ,5.958
Rx16714067102,RX,Q0162,16714067102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL ORAL SOLN 4 MG/5ML,1,35.94, 34.14 ,35.22, 34.14 , 34.86 , 34.14 ,Current Medicare Rates,34.86,34.5,Included in per diem,34.14,Included in ER Case rate,34.14,34.14, 35.22 ,32.346
Rx49281058905,RX,90734,49281058905,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MENINGOCOCCAL (A, C, Y, AND W-135) DIPHTH CONJUGATE VACCINE",1,321.33, 305.26 ,314.9, 305.26 , 311.69 , 305.26 ,Current Medicare Rates,311.69,308.48,Included in per diem,305.26,Included in ER Case rate,305.26,305.26, 314.90 ,289.197
Rx49281058958,RX,90734,49281058958,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MENINGOCOCCAL (A, C, Y, AND W-135) DIPHTH CONJUGATE VACCINE",1,322.37, 306.25 ,315.92, 306.25 , 312.70 , 306.25 ,Current Medicare Rates,312.7,309.48,Included in per diem,306.25,Included in ER Case rate,306.25,306.25, 315.92 ,290.133
Rx00641612501,RX,J2270,00641612501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN 4 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00641612525,RX,J2270,00641612525,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN 4 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx13533063402,RX,J1670,13533063402,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TETANUS IMMUNE GLOBULIN (HUMAN) IM SOLN PREF SYR 250 UNIT/ML,1,896.06, 851.26 ,878.14, 851.26 , 869.18 , 851.26 ,Current Medicare Rates,869.18,860.22,Included in per diem,851.26,Included in ER Case rate,851.26,851.26, 878.14 ,806.454
Rx00517003125,RX,J3420,00517003125,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYANOCOBALAMIN INJ 1000 MCG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323004400,RX,J3420,63323004400,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYANOCOBALAMIN INJ 1000 MCG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323004401,RX,J3420,63323004401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYANOCOBALAMIN INJ 1000 MCG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323039810,RX,J0456,63323039810,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AZITHROMYCIN IV FOR SOLN 500 MG,1,31.77, 30.18 ,31.13, 30.18 , 30.82 , 30.18 ,Current Medicare Rates,30.82,30.5,Included in per diem,30.18,Included in ER Case rate,30.18,30.18, 31.13 ,28.593
Rx00069315084,RX,J0456,00069315084,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AZITHROMYCIN IV FOR SOLN 500 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00052060202,RX,J9030,00052060202,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BCG LIVE INTRAVESICAL FOR SUSP 50 MG,1,598.92, 568.97 ,586.94, 568.97 , 580.95 , 568.97 ,Current Medicare Rates,580.95,574.96,Included in per diem,568.97,Included in ER Case rate,568.97,568.97, 586.94 ,539.028
Rx58160096412,RX,90675,58160096412,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"RABIES VACCINE, PCEC FOR INJ",1,954.33, 906.61 ,935.24, 906.61 , 925.70 , 906.61 ,Current Medicare Rates,925.7,916.16,Included in per diem,906.61,Included in ER Case rate,906.61,906.61, 935.24 ,858.897
Rx39822071001,RX,J1451,39822071001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION),1,1083.08," 1,028.93 ",1061.42," 1,028.93 "," 1,050.59 "," 1,028.93 ",Current Medicare Rates,1050.59,1039.76,Included in per diem,1028.93,Included in ER Case rate,1028.93,1028.93," 1,061.42 ",974.772
Rx67457021102,RX,J1451,67457021102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION),1,1735.85," 1,649.06 ",1701.13," 1,649.06 "," 1,683.77 "," 1,649.06 ",Current Medicare Rates,1683.77,1666.42,Included in per diem,1649.06,Included in ER Case rate,1649.06,1649.06," 1,701.13 ",1562.265
Rx70710147801,RX,J1451,70710147801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOMEPIZOLE INJ 1 GM/ML (FOR IV INFUSION),1,1002.38, 952.26 ,982.33, 952.26 , 972.31 , 952.26 ,Current Medicare Rates,972.31,962.28,Included in per diem,952.26,Included in ER Case rate,952.26,952.26, 982.33 ,902.142
Rx00409379301,RX,J1885,00409379301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 15 MG/ML,1,40.22, 38.21 ,39.42, 38.21 , 39.01 , 38.21 ,Current Medicare Rates,39.01,38.61,Included in per diem,38.21,Included in ER Case rate,38.21,38.21, 39.42 ,36.198
Rx00641604101,RX,J1885,00641604101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 15 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00409379319,RX,J1885,00409379319,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 15 MG/ML,1,40.27, 38.26 ,39.46, 38.26 , 39.06 , 38.26 ,Current Medicare Rates,39.06,38.66,Included in per diem,38.26,Included in ER Case rate,38.26,38.26, 39.46 ,36.243
Rx00338006910,RX,J1885,00338006910,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 15 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx72611071901,RX,J1885,72611071901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 15 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx72611071925,RX,J1885,72611071925,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 15 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx63323016101,RX,J1885,63323016101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 15 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00409379501,RX,J1885,00409379501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.15, 37.19 ,38.37, 37.19 , 37.98 , 37.19 ,Current Medicare Rates,37.98,37.58,Included in per diem,37.19,Included in ER Case rate,37.19,37.19, 38.37 ,35.235
Rx00409379519,RX,J1885,00409379519,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.19, 37.23 ,38.41, 37.23 , 38.01 , 37.23 ,Current Medicare Rates,38.01,37.62,Included in per diem,37.23,Included in ER Case rate,37.23,37.23, 38.41 ,35.271
Rx63323016216,RX,J1885,63323016216,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx69543038625,RX,J1885,69543038625,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx69543038630,RX,J1885,69543038630,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx70860070103,RX,J1885,70860070103,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx70860070100,RX,J1885,70860070100,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00338007225,RX,J1885,00338007225,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx63323016201,RX,J1885,63323016201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETOROLAC TROMETHAMINE INJ 30 MG/ML,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx55150021899,RX,J1327,55150021899,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML),1,223.14, 211.98 ,218.68, 211.98 , 216.45 , 211.98 ,Current Medicare Rates,216.45,214.21,Included in per diem,211.98,Included in ER Case rate,211.98,211.98, 218.68 ,200.826
Rx25021040851,RX,J1327,25021040851,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML),1,255.07, 242.32 ,249.97, 242.32 , 247.42 , 242.32 ,Current Medicare Rates,247.42,244.87,Included in per diem,242.32,Included in ER Case rate,242.32,242.32, 249.97 ,229.563
Rx00085113601,RX,J1327,00085113601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPTIFIBATIDE IV SOLN 75 MG/100ML (0.75 MG/ML),1,958.08, 910.18 ,938.92, 910.18 , 929.34 , 910.18 ,Current Medicare Rates,929.34,919.76,Included in per diem,910.18,Included in ER Case rate,910.18,910.18, 938.92 ,862.272
Rx55150015410,RX,J0133,55150015410,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACYCLOVIR SODIUM IV SOLN 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323032510,RX,J0133,63323032510,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACYCLOVIR SODIUM IV SOLN 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00054417925,RX,J8540,00054417925,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE TAB 0.5 MG,1,12.41, 11.79 ,12.16, 11.79 , 12.04 , 11.79 ,Current Medicare Rates,12.04,11.91,Included in per diem,11.79,Included in ER Case rate,11.79,11.79, 12.16 ,11.169
Rx00054817925,RX,J8540,00054817925,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE TAB 0.5 MG,1,13.06, 12.41 ,12.8, 12.41 , 12.67 , 12.41 ,Current Medicare Rates,12.67,12.54,Included in per diem,12.41,Included in ER Case rate,12.41,12.41, 12.80 ,11.754
Rx00054817525,RX,J8540,00054817525,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE TAB 4 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00641036721,RX,J1100,00641036721,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323016516,RX,J1100,63323016516,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323016502,RX,J1100,63323016502,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323016501,RX,J1100,63323016501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE SODIUM PHOSPHATE INJ 4 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx57894003001,RX,J1745,57894003001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),INFLIXIMAB FOR IV INJ 100 MG,1,1705.4," 1,620.13 ",1671.29," 1,620.13 "," 1,654.24 "," 1,620.13 ",Current Medicare Rates,1654.24,1637.18,Included in per diem,1620.13,Included in ER Case rate,1620.13,1620.13," 1,671.29 ",1534.86
Rx00409127332,RX,J3360,00409127332,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIAZEPAM INJ 5 MG/ML,1,39.63, 37.65 ,38.84, 37.65 , 38.44 , 37.65 ,Current Medicare Rates,38.44,38.04,Included in per diem,37.65,Included in ER Case rate,37.65,37.65, 38.84 ,35.667
Rx00409127303,RX,J3360,00409127303,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIAZEPAM INJ 5 MG/ML,1,39.76, 37.77 ,38.96, 37.77 , 38.57 , 37.77 ,Current Medicare Rates,38.57,38.17,Included in per diem,37.77,Included in ER Case rate,37.77,37.77, 38.96 ,35.784
Rx58914008052,RX,J0500,58914008052,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DICYCLOMINE HCL INJ 10 MG/ML,1,259.97, 246.97 ,254.77, 246.97 , 252.17 , 246.97 ,Current Medicare Rates,252.17,249.57,Included in per diem,246.97,Included in ER Case rate,246.97,246.97, 254.77 ,233.973
Rx17478001502,RX,J0500,17478001502,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DICYCLOMINE HCL INJ 10 MG/ML,1,138.02, 131.12 ,135.26, 131.12 , 133.88 , 131.12 ,Current Medicare Rates,133.88,132.5,Included in per diem,131.12,Included in ER Case rate,131.12,131.12, 135.26 ,124.218
Rx00409779362,RX,J1644,00409779362,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00264958720,RX,J1644,00264958720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00409779352,RX,J1644,00409779352,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx63323052374,RX,J1644,63323052374,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx63323052301,RX,J1644,63323052301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPARIN SODIUM (PORCINE) 100 UNIT/ML IN D5W,1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx00781305995,RX,J1160,00781305995,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIGOXIN INJ 0.25 MG/ML,1,23.5, 22.33 ,23.03, 22.33 , 22.80 , 22.33 ,Current Medicare Rates,22.8,22.56,Included in per diem,22.33,Included in ER Case rate,22.33,22.33, 23.03 ,21.15
Rx00641141031,RX,J1160,00641141031,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIGOXIN INJ 0.25 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641141035,RX,J1160,00641141035,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIGOXIN INJ 0.25 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00078081181,RX,J2353,00078081181,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OCTREOTIDE ACETATE FOR IM INJ KIT 10 MG,1,5673.26," 5,389.60 ",5559.79," 5,389.60 "," 5,503.06 "," 5,389.60 ",Current Medicare Rates,5503.06,5446.33,Included in per diem,5389.6,Included in ER Case rate,5389.6,5389.6," 5,559.79 ",5105.934
Rx00078081881,RX,J2353,00078081881,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OCTREOTIDE ACETATE FOR IM INJ KIT 20 MG,1,6629.39," 6,297.92 ",6496.8," 6,297.92 "," 6,430.51 "," 6,297.92 ",Current Medicare Rates,6430.51,6364.21,Included in per diem,6297.92,Included in ER Case rate,6297.92,6297.92," 6,496.80 ",5966.451
Rx00078082581,RX,J2353,00078082581,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OCTREOTIDE ACETATE FOR IM INJ KIT 30 MG,1,9927.03," 9,430.68 ",9728.49," 9,430.68 "," 9,629.22 "," 9,430.68 ",Current Medicare Rates,9629.22,9529.95,Included in per diem,9430.68,Included in ER Case rate,9430.68,9430.68," 9,728.49 ",8934.327
Rx00024279210,RX,J2916,00024279210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ),1,121.04, 114.99 ,118.62, 114.99 , 117.41 , 114.99 ,Current Medicare Rates,117.41,116.2,Included in per diem,114.99,Included in ER Case rate,114.99,114.99, 118.62 ,108.936
Rx00143957001,RX,J2916,00143957001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ),1,33.25, 31.59 ,32.59, 31.59 , 32.25 , 31.59 ,Current Medicare Rates,32.25,31.92,Included in per diem,31.59,Included in ER Case rate,31.59,31.59, 32.59 ,29.925
Rx00143957010,RX,J2916,00143957010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SOD FERRIC GLUC CMPLX IN SUCROSE IV SOLN 12.5 MG/ML (FE EQ),1,33.14, 31.48 ,32.48, 31.48 , 32.15 , 31.48 ,Current Medicare Rates,32.15,31.81,Included in per diem,31.48,Included in ER Case rate,31.48,31.48, 32.48 ,29.826
Rx00487950101,RX,J7613,00487950101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ALBUTEROL SULFATE SOLN NEBU 0.083% (2.5 MG/3ML),1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00641037621,RX,J1200,00641037621,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIPHENHYDRAMINE HCL INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641037625,RX,J1200,00641037625,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIPHENHYDRAMINE HCL INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323066416,RX,J1200,63323066416,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIPHENHYDRAMINE HCL INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323066401,RX,J1200,63323066401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIPHENHYDRAMINE HCL INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx24208034720,RX,J7611,24208034720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML),1,27.78, 26.39 ,27.22, 26.39 , 26.95 , 26.39 ,Current Medicare Rates,26.95,26.67,Included in per diem,26.39,Included in ER Case rate,26.39,26.39, 27.22 ,25.002
Rx50383074120,RX,J7611,50383074120,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ALBUTEROL SULFATE SOLN NEBU 0.5% (5 MG/ML),1,28.67, 27.24 ,28.1, 27.24 , 27.81 , 27.24 ,Current Medicare Rates,27.81,27.52,Included in per diem,27.24,Included in ER Case rate,27.24,27.24, 28.10 ,25.803
Rx00143954701,RX,J9000,00143954701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOXORUBICIN HCL INJ 2 MG/ML,1,167.11, 158.75 ,163.77, 158.75 , 162.10 , 158.75 ,Current Medicare Rates,162.1,160.43,Included in per diem,158.75,Included in ER Case rate,158.75,158.75, 163.77 ,150.399
Rx00008092351,RX,C9113,00008092351,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),1,22.13, 21.02 ,21.69, 21.02 , 21.47 , 21.02 ,Current Medicare Rates,21.47,21.24,Included in per diem,21.02,Included in ER Case rate,21.02,21.02, 21.69 ,19.917
Rx55150020200,RX,C9113,55150020200,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00517970225,RX,J1790,00517970225,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DROPERIDOL INJ 2.5 MG/ML,1,29.88, 28.39 ,29.28, 28.39 , 28.98 , 28.39 ,Current Medicare Rates,28.98,28.68,Included in per diem,28.39,Included in ER Case rate,28.39,28.39, 29.28 ,26.892
Rx00517970201,RX,J1790,00517970201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DROPERIDOL INJ 2.5 MG/ML,1,28.69, 27.26 ,28.12, 27.26 , 27.83 , 27.26 ,Current Medicare Rates,27.83,27.54,Included in per diem,27.26,Included in ER Case rate,27.26,27.26, 28.12 ,25.821
Rx25021012850,RX,J0713,25021012850,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTAZIDIME FOR IV SOLN 2 GM,1,38.54, 36.61 ,37.77, 36.61 , 37.38 , 36.61 ,Current Medicare Rates,37.38,37,Included in per diem,36.61,Included in ER Case rate,36.61,36.61, 37.77 ,34.686
Rx58160082011,RX,90744,58160082011,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML,1,64.43, 61.21 ,63.14, 61.21 , 62.50 , 61.21 ,Current Medicare Rates,62.5,61.85,Included in per diem,61.21,Included in ER Case rate,61.21,61.21, 63.14 ,57.987
Rx58160082043,RX,90744,58160082043,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPATITIS B VACCINE (RECOMBINANT) SUSP 10 MCG/0.5ML,1,96.94, 92.09 ,95, 92.09 , 94.03 , 92.09 ,Current Medicare Rates,94.03,93.06,Included in per diem,92.09,Included in ER Case rate,92.09,92.09, 95.00 ,87.246
Rx58160082143,RX,90746,58160082143,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPATITIS B VACCINE (RECOMBINANT) SUSP 20 MCG/ML,1,200.76, 190.72 ,196.74, 190.72 , 194.74 , 190.72 ,Current Medicare Rates,194.74,192.73,Included in per diem,190.72,Included in ER Case rate,190.72,190.72, 196.74 ,180.684
Rx00409113403,RX,J2270,00409113403,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN 50 MG/ML,1,38.57, 36.64 ,37.8, 36.64 , 37.41 , 36.64 ,Current Medicare Rates,37.41,37.03,Included in per diem,36.64,Included in ER Case rate,36.64,36.64, 37.80 ,34.713
Rx47335005040,RX,Q2050,47335005040,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DOXORUBICIN HCL LIPOSOMAL INJ (FOR IV INFUSION) 2 MG/ML,1,902.38, 857.26 ,884.33, 857.26 , 875.31 , 857.26 ,Current Medicare Rates,875.31,866.28,Included in per diem,857.26,Included in ER Case rate,857.26,857.26, 884.33 ,812.142
Rx62756035664,RX,Q0162,62756035664,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx68462015840,RX,Q0162,68462015840,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx62756035660,RX,Q0162,62756035660,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON ORALLY DISINTEGRATING TAB 8 MG,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx50242012001,RX,J3101,50242012001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TENECTEPLASE FOR IV SOLN KIT 50 MG,1,5733.08," 5,446.43 ",5618.42," 5,446.43 "," 5,561.09 "," 5,446.43 ",Current Medicare Rates,5561.09,5503.76,Included in per diem,5446.43,Included in ER Case rate,5446.43,5446.43," 5,618.42 ",5159.772
Rx00093681645,RX,J7626,00093681645,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUDESONIDE INHALATION SUSP 0.5 MG/2ML,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00781751687,RX,J7626,00781751687,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUDESONIDE INHALATION SUSP 0.5 MG/2ML,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00781751614,RX,J7626,00781751614,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUDESONIDE INHALATION SUSP 0.5 MG/2ML,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00487970101,RX,J7626,00487970101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUDESONIDE INHALATION SUSP 0.5 MG/2ML,1,16.6, 15.77 ,16.27, 15.77 , 16.10 , 15.77 ,Current Medicare Rates,16.1,15.94,Included in per diem,15.77,Included in ER Case rate,15.77,15.77, 16.27 ,14.94
Rx60687052479,RX,J7626,60687052479,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUDESONIDE INHALATION SUSP 0.5 MG/2ML,1,16.7, 15.87 ,16.37, 15.87 , 16.20 , 15.87 ,Current Medicare Rates,16.2,16.03,Included in per diem,15.87,Included in ER Case rate,15.87,15.87, 16.37 ,15.03
Rx60687052483,RX,J7626,60687052483,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUDESONIDE INHALATION SUSP 0.5 MG/2ML,1,16.65, 15.82 ,16.32, 15.82 , 16.15 , 15.82 ,Current Medicare Rates,16.15,15.98,Included in per diem,15.82,Included in ER Case rate,15.82,15.82, 16.32 ,14.985
Rx00185093330,RX,J7502,00185093330,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYCLOSPORINE MODIFIED CAP 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00093574219,RX,J7502,00093574219,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYCLOSPORINE MODIFIED CAP 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00185093386,RX,J7502,00185093386,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYCLOSPORINE MODIFIED CAP 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51862046047,RX,J7502,51862046047,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYCLOSPORINE MODIFIED CAP 100 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00517231005,RX,J1756,00517231005,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IRON SUCROSE INJ 20 MG/ML (FE EQUIV),1,68.54, 65.11 ,67.17, 65.11 , 66.48 , 65.11 ,Current Medicare Rates,66.48,65.8,Included in per diem,65.11,Included in ER Case rate,65.11,65.11, 67.17 ,61.686
Rx00517234010,RX,J1756,00517234010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IRON SUCROSE INJ 20 MG/ML (FE EQUIV),1,70.66, 67.13 ,69.25, 67.13 , 68.54 , 67.13 ,Current Medicare Rates,68.54,67.83,Included in per diem,67.13,Included in ER Case rate,67.13,67.13, 69.25 ,63.594
Rx00009027101,RX,J1000,00009027101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ESTRADIOL CYPIONATE IM IN OIL 5 MG/ML,1,87.94, 83.54 ,86.18, 83.54 , 85.30 , 83.54 ,Current Medicare Rates,85.3,84.42,Included in per diem,83.54,Included in ER Case rate,83.54,83.54, 86.18 ,79.146
Rx17856075902,RX,J7510,17856075902,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISOLONE SOD PHOSPHATE ORAL SOLN 15 MG/5ML (BASE EQUIV),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx50633011012,RX,J0840,50633011012,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CROTALIDAE POLYVALENT IMMUNE FAB (OVINE) FOR IV INFUSION,1,2815.02," 2,674.27 ",2758.72," 2,674.27 "," 2,730.57 "," 2,674.27 ",Current Medicare Rates,2730.57,2702.42,Included in per diem,2674.27,Included in ER Case rate,2674.27,2674.27," 2,758.72 ",2533.518
Rx61703034222,RX,J9267,61703034222,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML),1,207.49, 197.12 ,203.34, 197.12 , 201.27 , 197.12 ,Current Medicare Rates,201.27,199.19,Included in per diem,197.12,Included in ER Case rate,197.12,197.12, 203.34 ,186.741
Rx00703476601,RX,J9267,00703476601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML),1,272.71, 259.07 ,267.26, 259.07 , 264.53 , 259.07 ,Current Medicare Rates,264.53,261.8,Included in per diem,259.07,Included in ER Case rate,259.07,259.07, 267.26 ,245.439
Rx45963061353,RX,J9267,45963061353,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PACLITAXEL IV CONC 100 MG/16.7ML (6 MG/ML),1,200.13, 190.12 ,196.13, 190.12 , 194.13 , 190.12 ,Current Medicare Rates,194.13,192.12,Included in per diem,190.12,Included in ER Case rate,190.12,190.12, 196.13 ,180.117
Rx61703034250,RX,J9267,61703034250,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PACLITAXEL IV CONC 300 MG/50ML (6 MG/ML),1,282.19, 268.08 ,276.55, 268.08 , 273.72 , 268.08 ,Current Medicare Rates,273.72,270.9,Included in per diem,268.08,Included in ER Case rate,268.08,268.08, 276.55 ,253.971
Rx50242004164,RX,J2997,50242004164,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ALTEPLASE FOR INJ 2 MG,1,473.36, 449.69 ,463.89, 449.69 , 459.16 , 449.69 ,Current Medicare Rates,459.16,454.43,Included in per diem,449.69,Included in ER Case rate,449.69,449.69, 463.89 ,426.024
Rx50633012011,RX,J1162,50633012011,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIGOXIN IMMUNE FAB FOR INJ 40 MG,1,7276.11," 6,912.30 ",7130.59," 6,912.30 "," 7,057.83 "," 6,912.30 ",Current Medicare Rates,7057.83,6985.07,Included in per diem,6912.3,Included in ER Case rate,6912.3,6912.3," 7,130.59 ",6548.499
Rx00006384371,RX,J1335,00006384371,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT),1,397.91, 378.01 ,389.95, 378.01 , 385.97 , 378.01 ,Current Medicare Rates,385.97,381.99,Included in per diem,378.01,Included in ER Case rate,378.01,378.01, 389.95 ,358.119
Rx42023022110,RX,J1335,42023022110,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT),1,166.53, 158.20 ,163.2, 158.20 , 161.53 , 158.20 ,Current Medicare Rates,161.53,159.87,Included in per diem,158.2,Included in ER Case rate,158.2,158.2, 163.20 ,149.877
Rx42023022101,RX,J1335,42023022101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ERTAPENEM SODIUM FOR INJ 1 GM (BASE EQUIVALENT),1,167.07, 158.72 ,163.73, 158.72 , 162.06 , 158.72 ,Current Medicare Rates,162.06,160.39,Included in per diem,158.72,Included in ER Case rate,158.72,158.72, 163.73 ,150.363
Rx61703032618,RX,J2430,61703032618,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PAMIDRONATE DISODIUM IV SOLN 9 MG/ML,1,132.33, 125.71 ,129.68, 125.71 , 128.36 , 125.71 ,Current Medicare Rates,128.36,127.04,Included in per diem,125.71,Included in ER Case rate,125.71,125.71, 129.68 ,119.097
Rx67457044610,RX,J2430,67457044610,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PAMIDRONATE DISODIUM IV SOLN 9 MG/ML,1,106.79, 101.45 ,104.65, 101.45 , 103.59 , 101.45 ,Current Medicare Rates,103.59,102.52,Included in per diem,101.45,Included in ER Case rate,101.45,101.45, 104.65 ,96.111
Rx00409610202,RX,J1940,00409610202,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409610204,RX,J1940,00409610204,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409610210,RX,J1940,00409610210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx36000028425,RX,J1940,36000028425,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx36000028225,RX,J1940,36000028225,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx36000028325,RX,J1940,36000028325,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx63323028003,RX,J1940,63323028003,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx63323028005,RX,J1940,63323028005,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx00409610220,RX,J1940,00409610220,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx63323028004,RX,J1940,63323028004,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx63323028010,RX,J1940,63323028010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FUROSEMIDE INJ 10 MG/ML,1,49.44, 46.97 ,48.45, 46.97 , 47.96 , 46.97 ,Current Medicare Rates,47.96,47.46,Included in per diem,46.97,Included in ER Case rate,46.97,46.97, 48.45 ,44.496
Rx62935022305,RX,J9217,62935022305,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEUPROLIDE ACETATE (3 MONTH) FOR SUBCUTANEOUS INJ KIT 22.5MG,1,1052.57, 999.94 ,1031.52, 999.94 ," 1,020.99 ", 999.94 ,Current Medicare Rates,1020.99,1010.47,Included in per diem,999.94,Included in ER Case rate,999.94,999.94," 1,031.52 ",947.313
Rx63323017302,RX,J1580,63323017302,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GENTAMICIN SULFATE INJ 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409120703,RX,J1580,00409120703,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GENTAMICIN SULFATE INJ 40 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409120713,RX,J1580,00409120713,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GENTAMICIN SULFATE INJ 40 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323001002,RX,J1580,63323001002,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GENTAMICIN SULFATE INJ 40 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323001020,RX,J1580,63323001020,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GENTAMICIN SULFATE INJ 40 MG/ML,1,92.51, 87.88 ,90.66, 87.88 , 89.73 , 87.88 ,Current Medicare Rates,89.73,88.81,Included in per diem,87.88,Included in ER Case rate,87.88,87.88, 90.66 ,83.259
Rx00264310311,RX,J0690,00264310311,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFAZOLIN SODIUM FOR IV SOLN 1 GM AND DEXTROSE 4% (50 ML),1,62.54, 59.41 ,61.29, 59.41 , 60.66 , 59.41 ,Current Medicare Rates,60.66,60.04,Included in per diem,59.41,Included in ER Case rate,59.41,59.41, 61.29 ,56.286
Rx25021080166,RX,J3489,25021080166,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ZOLEDRONIC ACID INJ CONC FOR IV INFUSION 4 MG/5ML,1,556.68, 528.85 ,545.55, 528.85 , 539.98 , 528.85 ,Current Medicare Rates,539.98,534.41,Included in per diem,528.85,Included in ER Case rate,528.85,528.85, 545.55 ,501.012
Rx67457042612,RX,J1630,67457042612,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HALOPERIDOL LACTATE INJ 5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457042600,RX,J1630,67457042600,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HALOPERIDOL LACTATE INJ 5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143950101,RX,J1630,00143950101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HALOPERIDOL LACTATE INJ 5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143950125,RX,J1630,00143950125,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HALOPERIDOL LACTATE INJ 5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323047401,RX,J1630,63323047401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HALOPERIDOL LACTATE INJ 5 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00338070434,RX,J3480,00338070434,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KCL 20 MEQ/L (0.15%) IN NACL 0.45% INJ,1,93.98, 89.28 ,92.1, 89.28 , 91.16 , 89.28 ,Current Medicare Rates,91.16,90.22,Included in per diem,89.28,Included in ER Case rate,89.28,89.28, 92.10 ,84.582
Rx62856079701,RX,J2469,62856079701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PALONOSETRON HCL IV SOLN 0.25 MG/5ML (BASE EQUIVALENT),1,623.77, 592.58 ,611.29, 592.58 , 605.06 , 592.58 ,Current Medicare Rates,605.06,598.82,Included in per diem,592.58,Included in ER Case rate,592.58,592.58, 611.29 ,561.393
Rx63323061400,RX,J0360,63323061400,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYDRALAZINE HCL INJ 20 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323061401,RX,J0360,63323061401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYDRALAZINE HCL INJ 20 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67919001101,RX,J0878,67919001101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DAPTOMYCIN FOR IV SOLN 500 MG,1,786.81, 747.47 ,771.07, 747.47 , 763.21 , 747.47 ,Current Medicare Rates,763.21,755.34,Included in per diem,747.47,Included in ER Case rate,747.47,747.47, 771.07 ,708.129
Rx00703012501,RX,J0878,00703012501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DAPTOMYCIN FOR IV SOLN 500 MG,1,77.77, 73.88 ,76.21, 73.88 , 75.44 , 73.88 ,Current Medicare Rates,75.44,74.66,Included in per diem,73.88,Included in ER Case rate,73.88,73.88, 76.21 ,69.993
Rx71839010701,RX,J0878,71839010701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DAPTOMYCIN FOR IV SOLN 500 MG,1,87.55, 83.17 ,85.8, 83.17 , 84.92 , 83.17 ,Current Medicare Rates,84.92,84.05,Included in per diem,83.17,Included in ER Case rate,83.17,83.17, 85.80 ,78.795
Rx00409128331,RX,J1170,00409128331,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYDROMORPHONE HCL INJ 1 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00517560125,RX,J3410,00517560125,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYDROXYZINE HCL IM SOLN 50 MG/ML,1,33.33, 31.66 ,32.66, 31.66 , 32.33 , 31.66 ,Current Medicare Rates,32.33,32,Included in per diem,31.66,Included in ER Case rate,31.66,31.66, 32.66 ,29.997
Rx66733094823,RX,J9055,66733094823,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CETUXIMAB IV SOLN 100 MG/50ML (2 MG/ML),1,1422.73," 1,351.59 ",1394.28," 1,351.59 "," 1,380.05 "," 1,351.59 ",Current Medicare Rates,1380.05,1365.82,Included in per diem,1351.59,Included in ER Case rate,1351.59,1351.59," 1,394.28 ",1280.457
Rx70121123901,RX,J9070,70121123901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYCLOPHOSPHAMIDE FOR INJ 1 GM,1,721, 684.95 ,706.58, 684.95 , 699.37 , 684.95 ,Current Medicare Rates,699.37,692.16,Included in per diem,684.95,Included in ER Case rate,684.95,684.95, 706.58 ,648.9
Rx70121123801,RX,J9070,70121123801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CYCLOPHOSPHAMIDE FOR INJ 500 MG,1,721, 684.95 ,706.58, 684.95 , 699.37 , 684.95 ,Current Medicare Rates,699.37,692.16,Included in per diem,684.95,Included in ER Case rate,684.95,684.95, 706.58 ,648.9
Rx63323096330,RX,J0132,63323096330,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETYLCYSTEINE INJ 200 MG/ML,1,581.46, 552.39 ,569.83, 552.39 , 564.02 , 552.39 ,Current Medicare Rates,564.02,558.2,Included in per diem,552.39,Included in ER Case rate,552.39,552.39, 569.83 ,523.314
Rx00574080530,RX,J0132,00574080530,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETYLCYSTEINE INJ 200 MG/ML,1,529.94, 503.44 ,519.34, 503.44 , 514.04 , 503.44 ,Current Medicare Rates,514.04,508.74,Included in per diem,503.44,Included in ER Case rate,503.44,503.44, 519.34 ,476.946
Rx55150025930,RX,J0132,55150025930,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETYLCYSTEINE INJ 200 MG/ML,1,160.3, 152.29 ,157.09, 152.29 , 155.49 , 152.29 ,Current Medicare Rates,155.49,153.89,Included in per diem,152.29,Included in ER Case rate,152.29,152.29, 157.09 ,144.27
Rx17478054202,RX,J0153,17478054202,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 6 MG/2ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021030167,RX,J0153,25021030167,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 6 MG/2ML,1,40.68, 38.65 ,39.87, 38.65 , 39.46 , 38.65 ,Current Medicare Rates,39.46,39.05,Included in per diem,38.65,Included in ER Case rate,38.65,38.65, 39.87 ,36.612
Rx63323065121,RX,J0153,63323065121,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 6 MG/2ML,1,43.99, 41.79 ,43.11, 41.79 , 42.67 , 41.79 ,Current Medicare Rates,42.67,42.23,Included in per diem,41.79,Included in ER Case rate,41.79,41.79, 43.11 ,39.591
Rx63323065189,RX,J0153,63323065189,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 6 MG/2ML,1,43.85, 41.66 ,42.97, 41.66 , 42.53 , 41.66 ,Current Medicare Rates,42.53,42.1,Included in per diem,41.66,Included in ER Case rate,41.66,41.66, 42.97 ,39.465
Rx61703033918,RX,J9045,61703033918,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARBOPLATIN IV SOLN 50 MG/5ML,1,151.6, 144.02 ,148.57, 144.02 , 147.05 , 144.02 ,Current Medicare Rates,147.05,145.54,Included in per diem,144.02,Included in ER Case rate,144.02,144.02, 148.57 ,136.44
Rx61703033922,RX,J9045,61703033922,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARBOPLATIN IV SOLN 150 MG/15ML,1,156.23, 148.42 ,153.11, 148.42 , 151.54 , 148.42 ,Current Medicare Rates,151.54,149.98,Included in per diem,148.42,Included in ER Case rate,148.42,148.42, 153.11 ,140.607
Rx00703424601,RX,J9045,00703424601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARBOPLATIN IV SOLN 150 MG/15ML,1,154.47, 146.75 ,151.38, 146.75 , 149.84 , 146.75 ,Current Medicare Rates,149.84,148.29,Included in per diem,146.75,Included in ER Case rate,146.75,146.75, 151.38 ,139.023
Rx61703033950,RX,J9045,61703033950,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARBOPLATIN IV SOLN 450 MG/45ML,1,196.3, 186.49 ,192.37, 186.49 , 190.41 , 186.49 ,Current Medicare Rates,190.41,188.45,Included in per diem,186.49,Included in ER Case rate,186.49,186.49, 192.37 ,176.67
Rx00703424801,RX,J9045,00703424801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARBOPLATIN IV SOLN 450 MG/45ML,1,206.92, 196.57 ,202.78, 196.57 , 200.71 , 196.57 ,Current Medicare Rates,200.71,198.64,Included in per diem,196.57,Included in ER Case rate,196.57,196.57, 202.78 ,186.228
Rx17478017101,RX,J7612,17478017101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVALBUTEROL HCL SOLN NEBU CONC 1.25 MG/0.5ML (BASE EQUIV),1,10.33, 9.81 ,10.12, 9.81 , 10.02 , 9.81 ,Current Medicare Rates,10.02,9.92,Included in per diem,9.81,Included in ER Case rate,9.81,9.81, 10.12 ,9.297
Rx63323065104,RX,J0153,63323065104,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 12 MG/4ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021030168,RX,J0153,25021030168,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 12 MG/4ML,1,30.51, 28.98 ,29.9, 28.98 , 29.59 , 28.98 ,Current Medicare Rates,29.59,29.29,Included in per diem,28.98,Included in ER Case rate,28.98,28.98, 29.90 ,27.459
Rx67457085400,RX,J0153,67457085400,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 12 MG/4ML,1,22.67, 21.54 ,22.22, 21.54 , 21.99 , 21.54 ,Current Medicare Rates,21.99,21.76,Included in per diem,21.54,Included in ER Case rate,21.54,21.54, 22.22 ,20.403
Rx63323065123,RX,J0153,63323065123,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 12 MG/4ML,1,39.18, 37.22 ,38.4, 37.22 , 38.00 , 37.22 ,Current Medicare Rates,38,37.61,Included in per diem,37.22,Included in ER Case rate,37.22,37.22, 38.40 ,35.262
Rx63323065190,RX,J0153,63323065190,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ADENOSINE IV SOLN 12 MG/4ML,1,39.05, 37.10 ,38.27, 37.10 , 37.88 , 37.10 ,Current Medicare Rates,37.88,37.49,Included in per diem,37.1,Included in ER Case rate,37.1,37.1, 38.27 ,35.145
Rx00023608201,RX,J1750,00023608201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON),1,30.05, 28.55 ,29.45, 28.55 , 29.15 , 28.55 ,Current Medicare Rates,29.15,28.85,Included in per diem,28.55,Included in ER Case rate,28.55,28.55, 29.45 ,27.045
Rx00023608210,RX,J1750,00023608210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IRON DEXTRAN INJ 50 MG/ML (ELEMENTAL IRON),1,32.82, 31.18 ,32.16, 31.18 , 31.84 , 31.18 ,Current Medicare Rates,31.84,31.51,Included in per diem,31.18,Included in ER Case rate,31.18,31.18, 32.16 ,29.538
Rx63323030602,RX,J3260,63323030602,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TOBRAMYCIN SULFATE INJ 80 MG/2ML (40 MG/ML) (BASE EQUIV),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx61703033956,RX,J9045,61703033956,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CARBOPLATIN IV SOLN 600 MG/60ML,1,213.16, 202.50 ,208.9, 202.50 , 206.77 , 202.50 ,Current Medicare Rates,206.77,204.63,Included in per diem,202.5,Included in ER Case rate,202.5,202.5, 208.90 ,191.844
Rx64406000801,RX,J2323,64406000801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NATALIZUMAB FOR IV INJ CONC 300 MG/15ML,1,14222.62," 13,511.49 ",13938.17," 13,511.49 "," 13,795.94 "," 13,511.49 ",Current Medicare Rates,13795.94,13653.72,Included in per diem,13511.49,Included in ER Case rate,13511.49,13511.49," 13,938.17 ",12800.358
Rx68817013450,RX,J9264,68817013450,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PACLITAXEL PROTEIN-BOUND PARTICLES FOR IV SUSP 100 MG,1,2980.73," 2,831.69 ",2921.12," 2,831.69 "," 2,891.31 "," 2,831.69 ",Current Medicare Rates,2891.31,2861.5,Included in per diem,2831.69,Included in ER Case rate,2831.69,2831.69," 2,921.12 ",2682.657
Rx63323026950,RX,J2704,63323026950,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx63323026965,RX,J2704,63323026965,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx63323026959,RX,J2704,63323026959,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx63323026969,RX,J2704,63323026969,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",1,108.15, 102.74 ,105.99, 102.74 , 104.91 , 102.74 ,Current Medicare Rates,104.91,103.82,Included in per diem,102.74,Included in ER Case rate,102.74,102.74, 105.99 ,97.335
Rx25021060851,RX,J2704,25021060851,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"PROPOFOL IV EMUL 1000 MG/100ML (10 MG/ML),PROPOFOL IV EMUL 500 MG/50ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML)",1,114.61, 108.88 ,112.32, 108.88 , 111.17 , 108.88 ,Current Medicare Rates,111.17,110.03,Included in per diem,108.88,Included in ER Case rate,108.88,108.88, 112.32 ,103.149
Rx00409477702,RX,J0744,00409477702,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CIPROFLOXACIN 400 MG/200ML IN D5W,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00009514001,RX,J2020,00009514001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"LINEZOLID IV SOLN 200 MG/100ML (2 MG/ML),LINEZOLID IV SOLN 600 MG/300ML (2 MG/ML),LINEZOLID IN SODIUM CHLORIDE IV SOLN 600 MG/300ML-0.9%",1,73.69, 70.01 ,72.22, 70.01 , 71.48 , 70.01 ,Current Medicare Rates,71.48,70.74,Included in per diem,70.01,Included in ER Case rate,70.01,70.01, 72.22 ,66.321
Rx43825010201,RX,J0131,43825010201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ACETAMINOPHEN IV SOLN 10 MG/ML,1,30.12, 28.61 ,29.52, 28.61 , 29.22 , 28.61 ,Current Medicare Rates,29.22,28.92,Included in per diem,28.61,Included in ER Case rate,28.61,28.61, 29.52 ,27.108
Rx25021011382,RX,J0744,25021011382,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUCONAZOLE IN NACL 0.9% INJ 200 MG/100ML,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,Included in per diem,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
Rx00597026010,RX,J1610,00597026010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),GLUCAGON HCL (RDNA) DIAGNOSTIC FOR INJ 1 MG (BASE EQUIV),1,530.71, 504.17 ,520.1, 504.17 , 514.79 , 504.17 ,Current Medicare Rates,514.79,509.48,Included in per diem,504.17,Included in ER Case rate,504.17,504.17, 520.10 ,477.639
Rx76329124001,RX,J3430,76329124001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHYTONADIONE INJ 1 MG/0.5ML (2 MG/ML),1,90.85, 86.31 ,89.03, 86.31 , 88.12 , 86.31 ,Current Medicare Rates,88.12,87.22,Included in per diem,86.31,Included in ER Case rate,86.31,86.31, 89.03 ,81.765
Rx49281040010,RX,90715,49281040010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2-15.5 LF-LF-MCG/0.5ML,1,136.49, 129.67 ,133.76, 129.67 , 132.40 , 129.67 ,Current Medicare Rates,132.4,131.03,Included in per diem,129.67,Included in ER Case rate,129.67,129.67, 133.76 ,122.841
Rx49281040058,RX,90715,49281040058,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2-15.5 LF-LF-MCG/0.5ML,1,136.91, 130.06 ,134.17, 130.06 , 132.80 , 130.06 ,Current Medicare Rates,132.8,131.43,Included in per diem,130.06,Included in ER Case rate,130.06,130.06, 134.17 ,123.219
Rx49281040089,RX,90715,49281040089,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TET TOX-DIPH-ACELL PERTUSS AD INJ 5-2-15.5 LF-LF-MCG/0.5ML,1,136.9, 130.06 ,134.16, 130.06 , 132.79 , 130.06 ,Current Medicare Rates,132.79,131.42,Included in per diem,130.06,Included in ER Case rate,130.06,130.06, 134.16 ,123.21
Rx00264315511,RX,J0696,00264315511,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTRIAXONE SODIUM FOR IV SOLN 2 GM AND DEXTROSE 2.22% 50 ML,1,105.42, 100.15 ,103.31, 100.15 , 102.26 , 100.15 ,Current Medicare Rates,102.26,101.2,Included in per diem,100.15,Included in ER Case rate,100.15,100.15, 103.31 ,94.878
Rx00264315311,RX,J0696,00264315311,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTRIAXONE SODIUM FOR IV SOLN 1 GM AND DEXTROSE 3.74% 50 ML,1,88.93, 84.48 ,87.15, 84.48 , 86.26 , 84.48 ,Current Medicare Rates,86.26,85.37,Included in per diem,84.48,Included in ER Case rate,84.48,84.48, 87.15 ,80.037
Rx67457018100,RX,J3490,67457018100,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETAMINE HCL INJ 10 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409205105,RX,J3490,00409205105,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETAMINE HCL INJ 100 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx42023011510,RX,J3490,42023011510,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),KETAMINE HCL INJ 100 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00000000310,RX,J0694,00000000310,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFOXITIN 100 MG/ML IV SYRINGE,1,19.17, 18.21 ,18.79, 18.21 , 18.59 , 18.21 ,Current Medicare Rates,18.59,18.4,Included in per diem,18.21,Included in ER Case rate,18.21,18.21, 18.79 ,17.253
Rx00009001103,RX,J1720,00009001103,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYDROCORTISONE SODIUM SUCCINATE PF FOR INJ 100 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx61553067244,RX,J3010,61553067244,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML",1,73.97, 70.27 ,72.49, 70.27 , 71.75 , 70.27 ,Current Medicare Rates,71.75,71.01,Included in per diem,70.27,Included in ER Case rate,70.27,70.27, 72.49 ,66.573
Rx71449001332,RX,J3010,71449001332,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL 50 MCG/ML PCA/INFUSION,FENTANYL CITRATE IV SOLN 2500 MCG/50ML,FENTANYL CITRATE IV SOLN 5000 MCG/100ML,FENTANYL CITRATE INJ 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2750 MCG/55ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 2500 MCG/50ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1000 MCG/20ML,FENTANYL CITRATE IV SOLN 1500 MCG/30ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 1250 MCG/25ML",1,67.81, 64.42 ,66.45, 64.42 , 65.78 , 64.42 ,Current Medicare Rates,65.78,65.1,Included in per diem,64.42,Included in ER Case rate,64.42,64.42, 66.45 ,61.029
Rx00641604401,RX,J2060,00641604401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"LORAZEPAM INJ 2 MG/ML,LORAZEPAM INJ 4 MG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409672924,RX,J3475,00409672924,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML),1,91.11, 86.55 ,89.29, 86.55 , 88.38 , 86.55 ,Current Medicare Rates,88.38,87.47,Included in per diem,86.55,Included in ER Case rate,86.55,86.55, 89.29 ,81.999
Rx63323010605,RX,J3475,63323010605,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IV SOLN 2 GM/50ML (40 MG/ML),1,48.02, 45.62 ,47.06, 45.62 , 46.58 , 45.62 ,Current Medicare Rates,46.58,46.1,Included in per diem,45.62,Included in ER Case rate,45.62,45.62, 47.06 ,43.218
Rx00000000339,RX,J2175,00000000339,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MEPERIDINE HCL INJ 25 MG/ML,MEPERIDINE HCL INJ 50 MG/ML,MEPERIDINE HCL INJ 100 MG/ML,MEPERIDINE HCL INJ 75 MG/ML,MEPERIDINE HCL INJ 25 MG/0.5ML (50 MG/ML),MEPERIDINE HCL INJ 100 MG/2ML (50 MG/ML)",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx52533013248,RX,J2270,52533013248,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MORPHINE SULFATE IV SOLN 5 MG/ML,1,120.04, 114.04 ,117.64, 114.04 , 116.44 , 114.04 ,Current Medicare Rates,116.44,115.24,Included in per diem,114.04,Included in ER Case rate,114.04,114.04, 117.64 ,108.036
Rx00000000338,RX,J2270,00000000338,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ 10 MG/ML,MORPHINE SULFATE INJ 5 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 10 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 8 MG/ML,MORPHINE SULFATE IV SOLN PF 8 MG/ML,MORPHINE SULFATE-NACL PF SOL PREF SYR 0.5 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 2 MG/ML-0.9%,MORPHINE SULFATE-NACL SOLN PREF SYR 1 MG/ML-0.9%,MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE INJ PF 5 MG/ML,MORPHINE SULFATE INJ PF 8 MG/ML,MORPHINE SULFATE INJ PF 10 MG/ML,MORPHINE SULFATE INJ 1 MG/ML,MORPHINE SULFATE-NACL SOLN PREF SYR 4 MG/ML-0.9%,MORPHINE SULFATE IV SOLN 8 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML,MORPHINE SULFATE IV SOLN 0.5 MG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx63323010601,RX,J3475,63323010601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML),1,39.24, 37.28 ,38.46, 37.28 , 38.06 , 37.28 ,Current Medicare Rates,38.06,37.67,Included in per diem,37.28,Included in ER Case rate,37.28,37.28, 38.46 ,35.316
Rx63323010600,RX,J3475,63323010600,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE IV SOLN 4 GM/100ML (40 MG/ML),1,47.74, 45.35 ,46.79, 45.35 , 46.31 , 45.35 ,Current Medicare Rates,46.31,45.83,Included in per diem,45.35,Included in ER Case rate,45.35,45.35, 46.79 ,42.966
Rx00000003352,RX,J1170,00000003352,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL INJ 2 MG/ML,HYDROMORPHONE HCL INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 2 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 2 MG/ML,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 4 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.2 MG/0.2ML-0.9%,HYDROMORPHONE HCL-NACL SOLN PREF SYR 0.5 MG/0.5ML-0.9%",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx25021081430,RX,J0640,25021081430,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEUCOVORIN CALCIUM FOR INJ 100 MG,1,28.69, 27.26 ,28.12, 27.26 , 27.83 , 27.26 ,Current Medicare Rates,27.83,27.54,Included in per diem,27.26,Included in ER Case rate,27.26,27.26, 28.12 ,25.821
Rx25021081630,RX,J0640,25021081630,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEUCOVORIN CALCIUM FOR INJ 350 MG,1,54.6, 51.87 ,53.51, 51.87 , 52.96 , 51.87 ,Current Medicare Rates,52.96,52.42,Included in per diem,51.87,Included in ER Case rate,51.87,51.87, 53.51 ,49.14
Rx00409427601,RX,J2001,00409427601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048527,RX,J2001,63323048527,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409427616,RX,J2001,00409427616,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323048501,RX,J2001,63323048501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL INJ 1%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409427701,RX,J2001,00409427701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL INJ 2%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409427716,RX,J2001,00409427716,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LIDOCAINE HCL LOCAL INJ 2%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781340485,RX,J0290,00781340485,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150011310,RX,J0290,55150011310,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323038910,RX,J0290,63323038910,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 1 GM,1,25.41, 24.14 ,24.9, 24.14 , 24.65 , 24.14 ,Current Medicare Rates,24.65,24.39,Included in per diem,24.14,Included in ER Case rate,24.14,24.14, 24.90 ,22.869
Rx00781340880,RX,J0290,00781340880,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 2 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323039923,RX,J0290,63323039923,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 2 GM,1,34.37, 32.65 ,33.68, 32.65 , 33.34 , 32.65 ,Current Medicare Rates,33.34,33,Included in per diem,32.65,Included in ER Case rate,32.65,32.65, 33.68 ,30.933
Rx63323006401,RX,J3475,63323006401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE INJ 50%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323006410,RX,J3475,63323006410,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MAGNESIUM SULFATE INJ 50%,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781340295,RX,J0290,00781340295,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 250 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00781340278,RX,J0290,00781340278,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 250 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx55150011110,RX,J0290,55150011110,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN SODIUM FOR INJ 250 MG,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00000005102,RX,J7512,00000005102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 5 MG,1,6.26, 5.95 ,6.13, 5.95 , 6.07 , 5.95 ,Current Medicare Rates,6.07,6.01,Included in per diem,5.95,Included in ER Case rate,5.95,5.95, 6.13 ,5.634
Rx00409117630,RX,J2175,00409117630,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),MEPERIDINE HCL INJ 25 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx51079067001,RX,J8610,51079067001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHOTREXATE SODIUM TAB 2.5 MG (BASE EQUIV),1,128.75, 122.31 ,126.18, 122.31 , 124.89 , 122.31 ,Current Medicare Rates,124.89,123.6,Included in per diem,122.31,Included in ER Case rate,122.31,122.31, 126.18 ,115.875
Rx68084014901,RX,J7509,68084014901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE TAB 4 MG,1,7.2, 6.84 ,7.06, 6.84 , 6.98 , 6.84 ,Current Medicare Rates,6.98,6.91,Included in per diem,6.84,Included in ER Case rate,6.84,6.84, 7.06 ,6.48
Rx68084014911,RX,J7509,68084014911,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE TAB 4 MG,1,5.95, 5.65 ,5.83, 5.65 , 5.77 , 5.65 ,Current Medicare Rates,5.77,5.71,Included in per diem,5.65,Included in ER Case rate,5.65,5.65, 5.83 ,5.355
Rx63739013310,RX,J7509,63739013310,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE TAB 4 MG,1,6.14, 5.83 ,6.02, 5.83 , 5.96 , 5.83 ,Current Medicare Rates,5.96,5.89,Included in per diem,5.83,Included in ER Case rate,5.83,5.83, 6.02 ,5.526
Rx59746000106,RX,J7509,59746000106,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE TAB 4 MG,1,6.93, 6.58 ,6.79, 6.58 , 6.72 , 6.58 ,Current Medicare Rates,6.72,6.65,Included in per diem,6.58,Included in ER Case rate,6.58,6.58, 6.79 ,6.237
Rx00009307301,RX,J1030,00009307301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE ACETATE INJ SUSP 40 MG/ML,1,22.11, 21.00 ,21.67, 21.00 , 21.45 , 21.00 ,Current Medicare Rates,21.45,21.23,Included in per diem,21,Included in ER Case rate,21,21, 21.67 ,19.899
Rx00009347501,RX,J1040,00009347501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML,1,60.67, 57.64 ,59.46, 57.64 , 58.85 , 57.64 ,Current Medicare Rates,58.85,58.24,Included in per diem,57.64,Included in ER Case rate,57.64,57.64, 59.46 ,54.603
Rx00009347503,RX,J1040,00009347503,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHYLPREDNISOLONE ACETATE INJ SUSP 80 MG/ML,1,45.51, 43.23 ,44.6, 43.23 , 44.14 , 43.23 ,Current Medicare Rates,44.14,43.69,Included in per diem,43.23,Included in ER Case rate,43.23,43.23, 44.60 ,40.959
Rx00409341401,RX,J2765,00409341401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00703450201,RX,J2765,00703450201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409341418,RX,J2765,00409341418,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METOCLOPRAMIDE HCL INJ 5 MG/ML (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409121501,RX,J2310,00409121501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NALOXONE HCL INJ 0.4 MG/ML,1,65.77, 62.48 ,64.45, 62.48 , 63.80 , 62.48 ,Current Medicare Rates,63.8,63.14,Included in per diem,62.48,Included in ER Case rate,62.48,62.48, 64.45 ,59.193
Rx67457029200,RX,J2310,67457029200,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NALOXONE HCL INJ 0.4 MG/ML,1,20.22, 19.21 ,19.82, 19.21 , 19.61 , 19.21 ,Current Medicare Rates,19.61,19.41,Included in per diem,19.21,Included in ER Case rate,19.21,19.21, 19.82 ,18.198
Rx67457029202,RX,J2310,67457029202,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NALOXONE HCL INJ 0.4 MG/ML,1,20.15, 19.14 ,19.75, 19.14 , 19.55 , 19.14 ,Current Medicare Rates,19.55,19.34,Included in per diem,19.14,Included in ER Case rate,19.14,19.14, 19.75 ,18.135
Rx70069007101,RX,J2310,70069007101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),NALOXONE HCL INJ 0.4 MG/ML,1,62.47, 59.35 ,61.22, 59.35 , 60.60 , 59.35 ,Current Medicare Rates,60.6,59.97,Included in per diem,59.35,Included in ER Case rate,59.35,59.35, 61.22 ,56.223
Rx42023011625,RX,J2590,42023011625,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OXYTOCIN INJ 10 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323001203,RX,J2590,63323001203,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),OXYTOCIN INJ 10 UNIT/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx51285020401,RX,J7300,51285020401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),COPPER IUD,1,1017.64, 966.76 ,997.29, 966.76 , 987.11 , 966.76 ,Current Medicare Rates,987.11,976.93,Included in per diem,966.76,Included in ER Case rate,966.76,966.76, 997.29 ,915.876
Rx00049052084,RX,J2540,00049052084,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PENICILLIN G POTASSIUM FOR INJ 5000000 UNIT,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00603506121,RX,Q0175,00603506121,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PERPHENAZINE TAB 4 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084060211,RX,Q0175,68084060211,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PERPHENAZINE TAB 4 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx00781104701,RX,Q0175,00781104701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PERPHENAZINE TAB 4 MG,1,15.68, 14.90 ,15.37, 14.90 , 15.21 , 14.90 ,Current Medicare Rates,15.21,15.05,Included in per diem,14.9,Included in ER Case rate,14.9,14.9, 15.37 ,14.112
Rx00641047721,RX,J2560,00641047721,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHENOBARBITAL SODIUM INJ 130 MG/ML,1,131.95, 125.35 ,129.31, 125.35 , 127.99 , 125.35 ,Current Medicare Rates,127.99,126.67,Included in per diem,125.35,Included in ER Case rate,125.35,125.35, 129.31 ,118.755
Rx00641049321,RX,J1165,00641049321,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHENYTOIN SODIUM INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx39822405002,RX,J1165,39822405002,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHENYTOIN SODIUM INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00641049325,RX,J1165,00641049325,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHENYTOIN SODIUM INJ 50 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409663501,RX,J3480,00409663501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),POTASSIUM CHLORIDE INJ 2 MEQ/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409665106,RX,J3480,00409665106,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),POTASSIUM CHLORIDE INJ 2 MEQ/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409663518,RX,J3480,00409663518,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),POTASSIUM CHLORIDE INJ 2 MEQ/ML,1,19.12, 18.16 ,18.74, 18.16 , 18.55 , 18.16 ,Current Medicare Rates,18.55,18.36,Included in per diem,18.16,Included in ER Case rate,18.16,18.16, 18.74 ,17.208
Rx00409665119,RX,J3480,00409665119,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),POTASSIUM CHLORIDE INJ 2 MEQ/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323096510,RX,J3480,63323096510,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),POTASSIUM CHLORIDE INJ 2 MEQ/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx60977014127,RX,J2730,60977014127,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PRALIDOXIME CHLORIDE FOR IV SOLN 1 GM,1,269.01, 255.56 ,263.63, 255.56 , 260.94 , 255.56 ,Current Medicare Rates,260.94,258.25,Included in per diem,255.56,Included in ER Case rate,255.56,255.56, 263.63 ,242.109
Rx59746017106,RX,J7512,59746017106,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00054474125,RX,J7512,00054474125,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00054873925,RX,J7512,00054873925,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 1 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00054001720,RX,J7512,00054001720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 10 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx63739051910,RX,J7512,63739051910,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 10 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00054001820,RX,J7512,00054001820,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 20 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00143973801,RX,J7512,00143973801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 20 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx60687014501,RX,J7512,60687014501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 20 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx60687014511,RX,J7512,60687014511,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 20 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx63739051810,RX,J7512,63739051810,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 5 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00054872425,RX,J7512,00054872425,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE TAB 5 MG,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00409190201,RX,J2690,00409190201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROCAINAMIDE HCL INJ 100 MG/ML,1,196.83, 186.99 ,192.89, 186.99 , 190.93 , 186.99 ,Current Medicare Rates,190.93,188.96,Included in per diem,186.99,Included in ER Case rate,186.99,186.99, 192.89 ,177.147
Rx76329339905,RX,J2690,76329339905,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROCAINAMIDE HCL INJ 100 MG/ML,1,174.19, 165.48 ,170.71, 165.48 , 168.96 , 165.48 ,Current Medicare Rates,168.96,167.22,Included in per diem,165.48,Included in ER Case rate,165.48,165.48, 170.71 ,156.771
Rx14789090107,RX,J2690,14789090107,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROCAINAMIDE HCL INJ 100 MG/ML,1,599.6, 569.62 ,587.61, 569.62 , 581.61 , 569.62 ,Current Medicare Rates,581.61,575.62,Included in per diem,569.62,Included in ER Case rate,569.62,569.62, 587.61 ,539.64
Rx14789090110,RX,J2690,14789090110,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROCAINAMIDE HCL INJ 100 MG/ML,1,881.43, 837.36 ,863.8, 837.36 , 854.99 , 837.36 ,Current Medicare Rates,854.99,846.17,Included in per diem,837.36,Included in ER Case rate,837.36,837.36, 863.80 ,793.287
Rx00641092821,RX,J2550,00641092821,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROMETHAZINE HCL INJ 25 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323022930,RX,J2720,63323022930,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PROTAMINE SULFATE INJ 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323018001,RX,J3415,63323018001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PYRIDOXINE HCL INJ 100 MG/ML,1,32.93, 31.28 ,32.27, 31.28 , 31.94 , 31.28 ,Current Medicare Rates,31.94,31.61,Included in per diem,31.28,Included in ER Case rate,31.28,31.28, 32.27 ,29.637
Rx00003218710,RX,J0129,00003218710,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ABATACEPT FOR IV SOLN 250 MG,1,1861.25," 1,768.19 ",1824.03," 1,768.19 "," 1,805.41 "," 1,768.19 ",Current Medicare Rates,1805.41,1786.8,Included in per diem,1768.19,Included in ER Case rate,1768.19,1768.19," 1,824.03 ",1675.125
Rx00378699789,RX,J7131,00378699789,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SODIUM CHLORIDE SOLN NEBU 3%,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00517101025,RX,J0461,00517101025,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ATROPINE SULFATE INJ 1 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00000001533,RX,J2543,00000001533,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN-TAZOBACTAM 2.25 G/20ML IV SYRINGE,1,68.02, 64.62 ,66.66, 64.62 , 65.98 , 64.62 ,Current Medicare Rates,65.98,65.3,Included in per diem,64.62,Included in ER Case rate,64.62,64.62, 66.66 ,61.218
Rx00000001534,RX,J2543,00000001534,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PIPERACILLIN-TAZOBACTAM 3.375 G/30ML IV SYRINGE,1,88.67, 84.24 ,86.9, 84.24 , 86.01 , 84.24 ,Current Medicare Rates,86.01,85.12,Included in per diem,84.24,Included in ER Case rate,84.24,84.24, 86.90 ,79.803
Rx00000004539,RX,J7512,00000004539,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE 20 MG,1,26.32, 25.00 ,25.79, 25.00 , 25.53 , 25.00 ,Current Medicare Rates,25.53,25.27,Included in per diem,25,Included in ER Case rate,25,25, 25.79 ,23.688
Rx70092109236,RX,J3010,70092109236,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL CITRATE-NACL 0.9% IV SOLN 2.5 MG/250ML,FENTANYL CITRATE-NACL PF 0.9% IV SOLN 1 MG/100 ML (10 MCG/ML),FENTANYL CITRATE-NACL 0.9% INJ SOLN 1 MG/100ML,FENTANYL CITRATE-NACL 0.9% INJ SOLN 2.5 MG/250ML",1,41.45, 39.38 ,40.62, 39.38 , 40.21 , 39.38 ,Current Medicare Rates,40.21,39.79,Included in per diem,39.38,Included in ER Case rate,39.38,39.38, 40.62 ,37.305
Rx00000004676,RX,J7512,00000004676,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISONE 10 MG (ED HOMEPACK) PO TABS,1,25.14, 23.88 ,24.64, 23.88 , 24.39 , 23.88 ,Current Medicare Rates,24.39,24.13,Included in per diem,23.88,Included in ER Case rate,23.88,23.88, 24.64 ,22.626
Rx00000001085,RX,J7613,00000001085,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% (ED HOMEPACK) IN NEBU,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00000001087,RX,J8540,00000001087,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEXAMETHASONE 0.5 MG (ED HOMEPACK) PO TABS,1,23.79, 22.60 ,23.31, 22.60 , 23.08 , 22.60 ,Current Medicare Rates,23.08,22.84,Included in per diem,22.6,Included in ER Case rate,22.6,22.6, 23.31 ,21.411
Rx00008092351,RX,C9113,00008092351,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PANTOPRAZOLE SODIUM FOR IV SOLN 40 MG (BASE EQUIV),1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00641234139,RX,J1170,00641234139,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYDROMORPHONE HCL INJ 2 MG/ML,1,64.45, 61.23 ,63.16, 61.23 , 62.52 , 61.23 ,Current Medicare Rates,62.52,61.87,Included in per diem,61.23,Included in ER Case rate,61.23,61.23, 63.16 ,58.005
Rx00641234141,RX,J1170,00641234141,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYDROMORPHONE HCL INJ 2 MG/ML,1,64.24, 61.03 ,62.96, 61.03 , 62.31 , 61.03 ,Current Medicare Rates,62.31,61.67,Included in per diem,61.03,Included in ER Case rate,61.03,61.03, 62.96 ,57.816
Rx76329333901,RX,J0461,76329333901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"ATROPINE SULFATE SOLN PREFILL SYR 0.5 MG/5ML (0.1 MG/ML),ATROPINE SULFATE SOLN PREFILL SYR 1 MG/10ML (0.1 MG/ML)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx50242013201,RX,J9355,50242013201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TRASTUZUMAB FOR IV SOLN 150 MG,1,3297.29," 3,132.43 ",3231.34," 3,132.43 "," 3,198.37 "," 3,132.43 ",Current Medicare Rates,3198.37,3165.4,Included in per diem,3132.43,Included in ER Case rate,3132.43,3132.43," 3,231.34 ",2967.561
Rx50242013210,RX,J9355,50242013210,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TRASTUZUMAB FOR IV SOLN 150 MG,1,3297.29," 3,132.43 ",3231.34," 3,132.43 "," 3,198.37 "," 3,132.43 ",Current Medicare Rates,3198.37,3165.4,Included in per diem,3132.43,Included in ER Case rate,3132.43,3132.43," 3,231.34 ",2967.561
Rx76329906100,RX,J0171,76329906100,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML,EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx42023015925,RX,J0171,42023015925,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML,EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx42023016801,RX,J0171,42023016801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML,EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx54288010301,RX,J0171,54288010301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML,EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx42023015901,RX,J0171,42023015901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"EPINEPHRINE INJ 1 MG/ML,EPINEPHRINE PF INJ 1 MG/ML,EPINEPHRINE INJ 1 MG/ML (1:1000),EPINEPHRINE INJ 30 MG/30ML,EPINEPHRINE INJ 30 MG/30ML (1 MG/ML) (1:1000)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409662902,RX,J0330,00409662902,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 200 MG/10ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 140 MG/7ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 200 MG/10ML (20 MG/ML)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx69918070025,RX,J0330,69918070025,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CHLORIDE SOL PREF SYR 200 MG/10ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 100 MG/5ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 140 MG/7ML (20 MG/ML),SUCCINYLCHOLINE CL INJ SOL PREF SYR 200 MG/10ML (20 MG/ML)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx76329331601,RX,J0171,76329331601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00409492120,RX,J0171,00409492120,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"EPINEPHRINE HCL-NACL IV SOL PREF SYR 1000 MCG/10ML-0.9%,EPINEPHRINE SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE-NACL SOLN PREF SYR 1 MG/10ML-0.9% (100 MCG/ML),EPINEPHRINE IV SOLN PREFILLED SYRINGE 1 MG/10ML (0.1 MG/ML),EPINEPHRINE IV SOLN 1 MG/10ML (0.1 MG/ML)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00409121501,RX,J2310,00409121501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx67457029200,RX,J2310,67457029200,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx67457029202,RX,J2310,67457029202,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx70069007101,RX,J2310,70069007101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"NALOXONE HCL INJ 0.4 MG/ML,NALOXONE HCL INJ 4 MG/10ML",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx63323026929,RX,J2704,63323026929,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"PROPOFOL IV EMUL 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 200 MG/20ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 100 MG/10ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 50 MG/5ML (10 MG/ML),PROPOFOL IV EMUL PREFILLED SYRINGE 150 MG/15ML (10 MG/ML)",1,3914," 3,718.30 ",3835.72," 3,718.30 "," 3,796.58 "," 3,718.30 ",Current Medicare Rates,3796.58,3757.44,Included in per diem,3718.3,Included in ER Case rate,3718.3,3718.3," 3,835.72 ",3522.6
Rx00409230505,RX,J2250,00409230505,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00641605725,RX,J2250,00641605725,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00641605901,RX,J2250,00641605901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00641605910,RX,J2250,00641605910,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00641605701,RX,J2250,00641605701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MIDAZOLAM HCL INJ 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 10 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 2 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/5ML (BASE EQUIVALENT),MIDAZOLAM INJ SOLN PREFILLED SYRINGE 2 MG/2ML,MIDAZOLAM IV SOLN PREFILLED SYRINGE 2 MG/2ML",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00409128331,RX,J1170,00409128331,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"HYDROMORPHONE HCL INJ 1 MG/ML,HYDROMORPHONE HCL-NACL SOLN PREF SYR 1 MG/ML-0.9%,HYDROMORPHONE HCL PRESERVATIVE FREE (PF) INJ 1 MG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409189001,RX,J2270,00409189001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00409189003,RX,J2270,00409189003,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MORPHINE SULFATE INJ PF 2 MG/ML,MORPHINE SULFATE IV SOLN PF 2 MG/ML,MORPHINE SULFATE INJ 2 MG/ML,MORPHINE SULFATE-NACL SOL PREF SYR 2 MG/ML-0.9%",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00409189101,RX,J2270,00409189101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MORPHINE SULFATE INJ 4 MG/ML,MORPHINE SULFATE INJ PF 4 MG/ML,MORPHINE SULFATE IV SOLN PF 4 MG/ML,MORPHINE SULFATE IV SOLN 4 MG/ML",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00409230801,RX,J2250,00409230801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00409230802,RX,J2250,00409230802,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"MIDAZOLAM HCL INJ 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 25 MG/5ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 5 MG/ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ 50 MG/10ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 10 MG/2ML (BASE EQUIVALENT),MIDAZOLAM HCL INJ PF 5 MG/ML (BASE EQUIVALENT)",1,46.35, 44.03 ,45.42, 44.03 , 44.96 , 44.03 ,Current Medicare Rates,44.96,44.5,Included in per diem,44.03,Included in ER Case rate,44.03,44.03, 45.42 ,41.715
Rx00409909425,RX,J3010,00409909425,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00641602725,RX,J3010,00641602725,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00641602701,RX,J3010,00641602701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409909418,RX,J3010,00409909418,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx63323080605,RX,J3010,63323080605,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx63323080613,RX,J3010,63323080613,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"FENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2MLFENTANYL CITRATE PF SOLN CARTRIDGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 1000 MCG/20ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 250 MCG/5ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 2500 MCG/50ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 500 MCG/10ML,FENTANYL CITRATE IV SOLN PREFILLED SYRINGE 100 MCG/2ML,FENTANYL CITRATE PRESERVATIVE FREE (PF) INJ 50 MCG/ML,FENTANYL CITRATE PF SOLN PREFILLED SYRINGE 50 MCG/ML",1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00409132305,RX,J2001,00409132305,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%)",1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx76329339001,RX,J2001,76329339001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"LIDOCAINE HCL (CARDIAC) IV SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL(CARDIAC) IV PF SOLN PREF SYR 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV SOLN 100 MG/5ML (2%),LIDOCAINE HCL (CARDIAC) IV PF SOLN 100 MG/5ML (2%),LIDOCAINE HCL LOCAL SOLN PREFILLED SYRINGE 100 MG/5ML (2%)",1,21.47, 20.40 ,21.04, 20.40 , 20.83 , 20.40 ,Current Medicare Rates,20.83,20.61,Included in per diem,20.4,Included in ER Case rate,20.4,20.4, 21.04 ,19.323
Rx00409662902,RX,J0330,00409662902,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,1,24.62, 23.39 ,24.13, 23.39 , 23.88 , 23.39 ,Current Medicare Rates,23.88,23.64,Included in per diem,23.39,Included in ER Case rate,23.39,23.39, 24.13 ,22.158
Rx69918070025,RX,J0330,69918070025,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),SUCCINYLCHOLINE CHLORIDE INJ 20 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx18657011702,RX,J3473,18657011702,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HYALURONIDASE HUMAN INJ 150 UNIT/ML,1,152.59, 144.96 ,149.54, 144.96 , 148.01 , 144.96 ,Current Medicare Rates,148.01,146.49,Included in per diem,144.96,Included in ER Case rate,144.96,144.96, 149.54 ,137.331
Rx25021078005,RX,J1953,25021078005,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),1,206, 195.70 ,201.88, 195.70 , 199.82 , 195.70 ,Current Medicare Rates,199.82,197.76,Included in per diem,195.7,Included in ER Case rate,195.7,195.7, 201.88 ,185.4
Rx63323040005,RX,J1953,63323040005,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),1,206, 195.70 ,201.88, 195.70 , 199.82 , 195.70 ,Current Medicare Rates,199.82,197.76,Included in per diem,195.7,Included in ER Case rate,195.7,195.7, 201.88 ,185.4
Rx55150017705,RX,J1953,55150017705,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),1,206, 195.70 ,201.88, 195.70 , 199.82 , 195.70 ,Current Medicare Rates,199.82,197.76,Included in per diem,195.7,Included in ER Case rate,195.7,195.7, 201.88 ,185.4
Rx63323040041,RX,J1953,63323040041,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),1,206, 195.70 ,201.88, 195.70 , 199.82 , 195.70 ,Current Medicare Rates,199.82,197.76,Included in per diem,195.7,Included in ER Case rate,195.7,195.7, 201.88 ,185.4
Rx63323040044,RX,J1953,63323040044,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),LEVETIRACETAM INJ 500 MG/5ML (100 MG/ML),1,206, 195.70 ,201.88, 195.70 , 199.82 , 195.70 ,Current Medicare Rates,199.82,197.76,Included in per diem,195.7,Included in ER Case rate,195.7,195.7, 201.88 ,185.4
Rx00143960601,RX,J9025,00143960601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AZACITIDINE FOR INJ 100 MG,1,721, 684.95 ,706.58, 684.95 , 699.37 , 684.95 ,Current Medicare Rates,699.37,692.16,Included in per diem,684.95,Included in ER Case rate,684.95,684.95, 706.58 ,648.9
Rx63323001301,RX,J3411,63323001301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),THIAMINE HCL INJ 100 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323001302,RX,J3411,63323001302,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),THIAMINE HCL INJ 100 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00003029305,RX,J3301,00003029305,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),TRIAMCINOLONE ACETONIDE INJ SUSP 40 MG/ML,1,21.16, 20.10 ,20.74, 20.10 , 20.53 , 20.10 ,Current Medicare Rates,20.53,20.31,Included in per diem,20.1,Included in ER Case rate,20.1,20.1, 20.74 ,19.044
Rx55111068852,RX,J3489,55111068852,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ZOLEDRONIC ACID IV SOLN 5 MG/100ML,1,123.78, 117.59 ,121.3, 117.59 , 120.07 , 117.59 ,Current Medicare Rates,120.07,118.83,Included in per diem,117.59,Included in ER Case rate,117.59,117.59, 121.30 ,111.402
Rx25021083082,RX,J3489,25021083082,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ZOLEDRONIC ACID IV SOLN 5 MG/100ML,1,108.76, 103.32 ,106.58, 103.32 , 105.50 , 103.32 ,Current Medicare Rates,105.5,104.41,Included in per diem,103.32,Included in ER Case rate,103.32,103.32, 106.58 ,97.884
Rx00703301811,RX,J9190,00703301811,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUOROURACIL IV SOLN 2.5 GM/50ML (50 MG/ML),1,197.2, 187.34 ,193.26, 187.34 , 191.28 , 187.34 ,Current Medicare Rates,191.28,189.31,Included in per diem,187.34,Included in ER Case rate,187.34,187.34, 193.26 ,177.48
Rx00703301511,RX,J9190,00703301511,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUOROURACIL IV SOLN 500 MG/10ML (50 MG/ML),1,140.66, 133.63 ,137.85, 133.63 , 136.44 , 133.63 ,Current Medicare Rates,136.44,135.03,Included in per diem,133.63,Included in ER Case rate,133.63,133.63, 137.85 ,126.594
Rx16729027605,RX,J9190,16729027605,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUOROURACIL IV SOLN 1 GM/20ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323011720,RX,J9190,63323011720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUOROURACIL IV SOLN 1 GM/20ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409433201,RX,J3370,00409433201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx47781059891,RX,J3370,47781059891,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx47781059807,RX,J3370,47781059807,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323022133,RX,J3370,63323022133,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409433211,RX,J3370,00409433211,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323022110,RX,J3370,63323022110,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 500 MG (BASE EQUIVALENT),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx61703030916,RX,J9370,61703030916,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VINCRISTINE SULFATE IV SOLN 1 MG/ML,1,158.5, 150.58 ,155.33, 150.58 , 153.75 , 150.58 ,Current Medicare Rates,153.75,152.16,Included in per diem,150.58,Included in ER Case rate,150.58,150.58, 155.33 ,142.65
Rx00409915801,RX,J3430,00409915801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHYTONADIONE INJ 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx43598040511,RX,J3430,43598040511,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHYTONADIONE INJ 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx43598040516,RX,J3430,43598040516,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PHYTONADIONE INJ 10 MG/ML,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00069600110,RX,Q2009,00069600110,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00069600121,RX,Q2009,00069600121,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOSPHENYTOIN SODIUM INJ 500 MG/10ML (PHENYTOIN EQUIV),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00069600102,RX,Q2009,00069600102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457051625,RX,Q2009,67457051625,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV),1,64.44, 61.22 ,63.15, 61.22 , 62.51 , 61.22 ,Current Medicare Rates,62.51,61.86,Included in per diem,61.22,Included in ER Case rate,61.22,61.22, 63.15 ,57.996
Rx67457051600,RX,Q2009,67457051600,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV),1,64.44, 61.22 ,63.15, 61.22 , 62.51 , 61.22 ,Current Medicare Rates,62.51,61.86,Included in per diem,61.22,Included in ER Case rate,61.22,61.22, 63.15 ,57.996
Rx64679072902,RX,Q2009,64679072902,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FOSPHENYTOIN SODIUM INJ 100 MG/2ML (PHENYTOIN EQUIV),1,20.97, 19.92 ,20.55, 19.92 , 20.34 , 19.92 ,Current Medicare Rates,20.34,20.13,Included in per diem,19.92,Included in ER Case rate,19.92,19.92, 20.55 ,18.873
Rx61703035038,RX,J9260,61703035038,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),METHOTREXATE SODIUM INJ 50 MG/2ML (25 MG/ML),1,138.41, 131.49 ,135.64, 131.49 , 134.26 , 131.49 ,Current Medicare Rates,134.26,132.87,Included in per diem,131.49,Included in ER Case rate,131.49,131.49, 135.64 ,124.569
Rx00703574711,RX,J9060,00703574711,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CISPLATIN INJ 50 MG/50ML (1 MG/ML),1,172.01, 163.41 ,168.57, 163.41 , 166.85 , 163.41 ,Current Medicare Rates,166.85,165.13,Included in per diem,163.41,Included in ER Case rate,163.41,163.41, 168.57 ,154.809
Rx63323010351,RX,J9060,63323010351,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CISPLATIN INJ 50 MG/50ML (1 MG/ML),1,155.86, 148.07 ,152.74, 148.07 , 151.18 , 148.07 ,Current Medicare Rates,151.18,149.63,Included in per diem,148.07,Included in ER Case rate,148.07,148.07, 152.74 ,140.274
Rx00703574811,RX,J9060,00703574811,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CISPLATIN INJ 100 MG/100ML (1 MG/ML),1,207.64, 197.26 ,203.49, 197.26 , 201.41 , 197.26 ,Current Medicare Rates,201.41,199.33,Included in per diem,197.26,Included in ER Case rate,197.26,197.26, 203.49 ,186.876
Rx63323010364,RX,J9060,63323010364,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CISPLATIN INJ 200 MG/200ML (1 MG/ML),1,245.96, 233.66 ,241.04, 233.66 , 238.58 , 233.66 ,Current Medicare Rates,238.58,236.12,Included in per diem,233.66,Included in ER Case rate,233.66,233.66, 241.04 ,221.364
Rx53270005201,RX,J1573,53270005201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPATITIS B IMMUNE GLOBULIN (HUMAN) INJ SOLN,1,401.7, 381.62 ,393.67, 381.62 , 389.65 , 381.62 ,Current Medicare Rates,389.65,385.63,Included in per diem,381.62,Included in ER Case rate,381.62,381.62, 393.67 ,361.53
Rx68516521601,RX,P9047,68516521601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"ALBUMIN, HUMAN INJ 25%",1,193.64, 183.96 ,189.77, 183.96 , 187.83 , 183.96 ,Current Medicare Rates,187.83,185.89,Included in per diem,183.96,Included in ER Case rate,183.96,183.96, 189.77 ,174.276
Rx50242008527,RX,J2997,50242008527,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ALTEPLASE FOR INJ 100 MG,1,13818.03," 13,127.13 ",13541.67," 13,127.13 "," 13,403.49 "," 13,127.13 ",Current Medicare Rates,13403.49,13265.31,Included in per diem,13127.13,Included in ER Case rate,13127.13,13127.13," 13,541.67 ",12436.227
Rx63323036820,RX,J0295,63323036820,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00049001381,RX,J0295,00049001381,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx71288000520,RX,J0295,71288000520,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM,1,22.46, 21.34 ,22.01, 21.34 , 21.79 , 21.34 ,Current Medicare Rates,21.79,21.56,Included in per diem,21.34,Included in ER Case rate,21.34,21.34, 22.01 ,20.214
Rx71288000521,RX,J0295,71288000521,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM,1,22.53, 21.40 ,22.08, 21.40 , 21.85 , 21.40 ,Current Medicare Rates,21.85,21.63,Included in per diem,21.4,Included in ER Case rate,21.4,21.4, 22.08 ,20.277
Rx00049001383,RX,J0295,00049001383,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 1.5 (1-0.5) GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021014330,RX,J0295,25021014330,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM,1,37.68, 35.80 ,36.93, 35.80 , 36.55 , 35.80 ,Current Medicare Rates,36.55,36.17,Included in per diem,35.8,Included in ER Case rate,35.8,35.8, 36.93 ,33.912
Rx55150011720,RX,J0295,55150011720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM,1,22.51, 21.38 ,22.06, 21.38 , 21.83 , 21.38 ,Current Medicare Rates,21.83,21.61,Included in per diem,21.38,Included in ER Case rate,21.38,21.38, 22.06 ,20.259
Rx00049001481,RX,J0295,00049001481,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMPICILLIN & SULBACTAM SODIUM FOR INJ 3 (2-1) GM,1,23.94, 22.74 ,23.46, 22.74 , 23.22 , 22.74 ,Current Medicare Rates,23.22,22.98,Included in per diem,22.74,Included in ER Case rate,22.74,22.74, 23.46 ,21.546
Rx58160082601,RX,90632,58160082601,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML,1,253.32, 240.65 ,248.25, 240.65 , 245.72 , 240.65 ,Current Medicare Rates,245.72,243.19,Included in per diem,240.65,Included in ER Case rate,240.65,240.65, 248.25 ,227.988
Rx58160082652,RX,90632,58160082652,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),HEPATITIS A VACCINE INJ SUSP 1440 EL UNIT/ML,1,238.55, 226.62 ,233.78, 226.62 , 231.39 , 226.62 ,Current Medicare Rates,231.39,229.01,Included in per diem,226.62,Included in ER Case rate,226.62,226.62, 233.78 ,214.695
Rx00009752903,RX,J9206,00009752903,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IRINOTECAN HCL INJ 100 MG/5ML (20 MG/ML),1,197.35, 187.48 ,193.4, 187.48 , 191.43 , 187.48 ,Current Medicare Rates,191.43,189.46,Included in per diem,187.48,Included in ER Case rate,187.48,187.48, 193.40 ,177.615
Rx00409477702,RX,J0744,00409477702,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CIPROFLOXACIN 400 MG/200ML IN D5W,1,40.37, 38.35 ,39.56, 38.35 , 39.16 , 38.35 ,Current Medicare Rates,39.16,38.76,Included in per diem,38.35,Included in ER Case rate,38.35,38.35, 39.56 ,36.333
Rx25021011487,RX,J0744,25021011487,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CIPROFLOXACIN 400 MG/200ML IN D5W,1,42.64, 40.51 ,41.79, 40.51 , 41.36 , 40.51 ,Current Medicare Rates,41.36,40.93,Included in per diem,40.51,Included in ER Case rate,40.51,40.51, 41.79 ,38.376
Rx36000000924,RX,J0744,36000000924,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CIPROFLOXACIN 400 MG/200ML IN D5W,1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx68084022901,RX,J7500,68084022901,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AZATHIOPRINE TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx68084022911,RX,J7500,68084022911,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AZATHIOPRINE TAB 50 MG,1,5.67, 5.39 ,5.56, 5.39 , 5.50 , 5.39 ,Current Medicare Rates,5.5,5.44,Included in per diem,5.39,Included in ER Case rate,5.39,5.39, 5.56 ,5.103
Rx51079062001,RX,J7500,51079062001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AZATHIOPRINE TAB 50 MG,1,7.83, 7.44 ,7.67, 7.44 , 7.60 , 7.44 ,Current Medicare Rates,7.6,7.52,Included in per diem,7.44,Included in ER Case rate,7.44,7.44, 7.67 ,7.047
Rx00517072001,RX,J0702,00517072001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML,1,29.97, 28.47 ,29.37, 28.47 , 29.07 , 28.47 ,Current Medicare Rates,29.07,28.77,Included in per diem,28.47,Included in ER Case rate,28.47,28.47, 29.37 ,26.973
Rx51754506001,RX,J0702,51754506001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BETAMETHASONE SOD PHOSPHATE & ACETATE INJ SUSP 6 (3-3) MG/ML,1,29.63, 28.15 ,29.04, 28.15 , 28.74 , 28.15 ,Current Medicare Rates,28.74,28.44,Included in per diem,28.15,Included in ER Case rate,28.15,28.15, 29.04 ,26.667
Rx67457015303,RX,J0282,67457015303,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457015300,RX,J0282,67457015300,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00143987501,RX,J0282,00143987501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323061603,RX,J0282,63323061603,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMIODARONE HCL INJ 150 MG/3ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409162301,RX,J0595,00409162301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),BUTORPHANOL TARTRATE INJ 1 MG/ML,1,25.75, 24.46 ,25.24, 24.46 , 24.98 , 24.46 ,Current Medicare Rates,24.98,24.72,Included in per diem,24.46,Included in ER Case rate,24.46,24.46, 25.24 ,23.175
Rx00487020101,RX,J7620,00487020101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),IPRATROPIUM-ALBUTEROL NEBU SOLN 0.5-2.5(3) MG/3ML,1,10.3, 9.79 ,10.09, 9.79 , 9.99 , 9.79 ,Current Medicare Rates,9.99,9.89,Included in per diem,9.79,Included in ER Case rate,9.79,9.79, 10.09 ,9.27
Rx00641607801,RX,J2405,00641607801,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx00409475518,RX,J2405,00409475518,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx23155054742,RX,J2405,23155054742,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx23155054831,RX,J2405,23155054831,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL INJ 4 MG/2ML (2 MG/ML),1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx36000001301,RX,J2405,36000001301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML),1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx70860077720,RX,J2405,70860077720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),ONDANSETRON HCL INJ 40 MG/20ML (2 MG/ML),1,39.14, 37.18 ,38.36, 37.18 , 37.97 , 37.18 ,Current Medicare Rates,37.97,37.57,Included in per diem,37.18,Included in ER Case rate,37.18,37.18, 38.36 ,35.226
Rx63323034129,RX,J0694,63323034129,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFOXITIN SODIUM FOR IV SOLN 1 GM,1,27.61, 26.23 ,27.06, 26.23 , 26.78 , 26.23 ,Current Medicare Rates,26.78,26.51,Included in per diem,26.23,Included in ER Case rate,26.23,26.23, 27.06 ,24.849
Rx44567024525,RX,J0694,44567024525,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFOXITIN SODIUM FOR IV SOLN 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx25021011020,RX,J0694,25021011020,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFOXITIN SODIUM FOR IV SOLN 2 GM,1,30.4, 28.88 ,29.79, 28.88 , 29.49 , 28.88 ,Current Medicare Rates,29.49,29.18,Included in per diem,28.88,Included in ER Case rate,28.88,28.88, 29.79 ,27.36
Rx63323034225,RX,J0694,63323034225,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFOXITIN SODIUM FOR IV SOLN 2 GM,1,54.55, 51.82 ,53.46, 51.82 , 52.91 , 51.82 ,Current Medicare Rates,52.91,52.37,Included in per diem,51.82,Included in ER Case rate,51.82,51.82, 53.46 ,49.095
Rx44567024625,RX,J0694,44567024625,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFOXITIN SODIUM FOR IV SOLN 2 GM,1,23.46, 22.29 ,22.99, 22.29 , 22.76 , 22.29 ,Current Medicare Rates,22.76,22.52,Included in per diem,22.29,Included in ER Case rate,22.29,22.29, 22.99 ,21.114
Rx00409508216,RX,J0713,00409508216,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTAZIDIME FOR INJ 1 GM,1,18.93, 17.98 ,18.55, 17.98 , 18.36 , 17.98 ,Current Medicare Rates,18.36,18.17,Included in per diem,17.98,Included in ER Case rate,17.98,17.98, 18.55 ,17.037
Rx25021012720,RX,J0713,25021012720,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTAZIDIME FOR INJ 1 GM,1,23.5, 22.33 ,23.03, 22.33 , 22.80 , 22.33 ,Current Medicare Rates,22.8,22.56,Included in per diem,22.33,Included in ER Case rate,22.33,22.33, 23.03 ,21.15
Rx00409508211,RX,J0713,00409508211,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTAZIDIME FOR INJ 1 GM,1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx00409733201,RX,J0696,00409733201,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTRIAXONE SODIUM FOR INJ 1 GM,1,89.15, 84.69 ,87.37, 84.69 , 86.48 , 84.69 ,Current Medicare Rates,86.48,85.58,Included in per diem,84.69,Included in ER Case rate,84.69,84.69, 87.37 ,80.235
Rx00409733211,RX,J0696,00409733211,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTRIAXONE SODIUM FOR INJ 1 GM,1,89.18, 84.72 ,87.4, 84.72 , 86.50 , 84.72 ,Current Medicare Rates,86.5,85.61,Included in per diem,84.72,Included in ER Case rate,84.72,84.72, 87.40 ,80.262
Rx00409733701,RX,J0696,00409733701,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTRIAXONE SODIUM FOR INJ 250 MG,1,119.61, 113.63 ,117.22, 113.63 , 116.02 , 113.63 ,Current Medicare Rates,116.02,114.83,Included in per diem,113.63,Included in ER Case rate,113.63,113.63, 117.22 ,107.649
Rx00409733820,RX,J0696,00409733820,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTRIAXONE SODIUM FOR INJ 500 MG,1,119.96, 113.96 ,117.56, 113.96 , 116.36 , 113.96 ,Current Medicare Rates,116.36,115.16,Included in per diem,113.96,Included in ER Case rate,113.96,113.96, 117.56 ,107.964
Rx00409733811,RX,J0696,00409733811,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),CEFTRIAXONE SODIUM FOR INJ 500 MG,1,119.97, 113.97 ,117.57, 113.97 , 116.37 , 113.97 ,Current Medicare Rates,116.37,115.17,Included in per diem,113.97,Included in ER Case rate,113.97,113.97, 117.57 ,107.973
Rx00548590000,RX,J0834,00548590000,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),COSYNTROPIN FOR INJ 0.25 MG,1,329.62, 313.14 ,323.03, 313.14 , 319.73 , 313.14 ,Current Medicare Rates,319.73,316.44,Included in per diem,313.14,Included in ER Case rate,313.14,313.14, 323.03 ,296.658
Rx00409233610,RX,J0895,00409233610,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEFEROXAMINE MESYLATE FOR INJ 500 MG,1,37.84, 35.95 ,37.08, 35.95 , 36.70 , 35.95 ,Current Medicare Rates,36.7,36.33,Included in per diem,35.95,Included in ER Case rate,35.95,35.95, 37.08 ,34.056
Rx63323059710,RX,J0895,63323059710,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DEFEROXAMINE MESYLATE FOR INJ 500 MG,1,47.36, 44.99 ,46.41, 44.99 , 45.94 , 44.99 ,Current Medicare Rates,45.94,45.47,Included in per diem,44.99,Included in ER Case rate,44.99,44.99, 46.41 ,42.624
Rx00409653102,RX,J3370,00409653102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT),1,31.99, 30.39 ,31.35, 30.39 , 31.03 , 30.39 ,Current Medicare Rates,31.03,30.71,Included in per diem,30.39,Included in ER Case rate,30.39,30.39, 31.35 ,28.791
Rx63323020320,RX,J3370,63323020320,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT),1,40.63, 38.60 ,39.82, 38.60 , 39.41 , 38.60 ,Current Medicare Rates,39.41,39,Included in per diem,38.6,Included in ER Case rate,38.6,38.6, 39.82 ,36.567
Rx63323020301,RX,J3370,63323020301,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),VANCOMYCIN HCL FOR IV SOLN 750 MG (BASE EQUIVALENT),1,40.76, 38.72 ,39.94, 38.72 , 39.54 , 38.72 ,Current Medicare Rates,39.54,39.13,Included in per diem,38.72,Included in ER Case rate,38.72,38.72, 39.94 ,36.684
Rx00703505101,RX,J2597,00703505101,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DESMOPRESSIN ACETATE INJ 4 MCG/ML,1,41.46, 39.39 ,40.63, 39.39 , 40.22 , 39.39 ,Current Medicare Rates,40.22,39.8,Included in per diem,39.39,Included in ER Case rate,39.39,39.39, 40.63 ,37.314
Rx00703505103,RX,J2597,00703505103,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DESMOPRESSIN ACETATE INJ 4 MCG/ML,1,41.33, 39.26 ,40.5, 39.26 , 40.09 , 39.26 ,Current Medicare Rates,40.09,39.68,Included in per diem,39.26,Included in ER Case rate,39.26,39.26, 40.50 ,37.197
Rx69918090110,RX,J2597,69918090110,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DESMOPRESSIN ACETATE INJ 4 MCG/ML,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,Included in per diem,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
Rx50383004224,RX,J7510,50383004224,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),PREDNISOLONE SYRUP 15 MG/5ML (USP SOLUTION EQUIVALENT),1,6.18, 5.87 ,6.06, 5.87 , 5.99 , 5.87 ,Current Medicare Rates,5.99,5.93,Included in per diem,5.87,Included in ER Case rate,5.87,5.87, 6.06 ,5.562
Rx63323061609,RX,J0282,63323061609,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMIODARONE HCL INJ 450 MG/9ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx67457015309,RX,J0282,67457015309,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),AMIODARONE HCL INJ 450 MG/9ML (50 MG/ML),1,18.54, 17.61 ,18.17, 17.61 , 17.98 , 17.61 ,Current Medicare Rates,17.98,17.8,Included in per diem,17.61,Included in ER Case rate,17.61,17.61, 18.17 ,16.686
Rx63323011761,RX,J9190,63323011761,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FLUOROURACIL IV SOLN 5 GM/100ML (50 MG/ML),1,183.75, 174.56 ,180.08, 174.56 , 178.24 , 174.56 ,Current Medicare Rates,178.24,176.4,Included in per diem,174.56,Included in ER Case rate,174.56,174.56, 180.08 ,165.375
Rx59338077501,RX,Q0138,59338077501,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE),1,1079.36," 1,025.39 ",1057.77," 1,025.39 "," 1,046.98 "," 1,025.39 ",Current Medicare Rates,1046.98,1036.19,Included in per diem,1025.39,Included in ER Case rate,1025.39,1025.39," 1,057.77 ",971.424
Rx00781315401,RX,Q0138,00781315401,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),FERUMOXYTOL INJ 510 MG/17ML (30 MG/ML) (ELEMENTAL FE),1,1005.15, 954.89 ,985.05, 954.89 , 975.00 , 954.89 ,Current Medicare Rates,975,964.94,Included in per diem,954.89,Included in ER Case rate,954.89,954.89, 985.05 ,904.635
Rx00574085010,RX,J1110,00574085010,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML,1,385.92, 366.62 ,378.2, 366.62 , 374.34 , 366.62 ,Current Medicare Rates,374.34,370.48,Included in per diem,366.62,Included in ER Case rate,366.62,366.62, 378.20 ,347.328
Rx00574085005,RX,J1110,00574085005,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML,1,196.11, 186.30 ,192.19, 186.30 , 190.23 , 186.30 ,Current Medicare Rates,190.23,188.27,Included in per diem,186.3,Included in ER Case rate,186.3,186.3, 192.19 ,176.499
Rx61990041102,RX,J1110,61990041102,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML,1,149.88, 142.39 ,146.88, 142.39 , 145.38 , 142.39 ,Current Medicare Rates,145.38,143.88,Included in per diem,142.39,Included in ER Case rate,142.39,142.39, 146.88 ,134.892
Rx61990041100,RX,J1110,61990041100,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML,1,53.7, 51.02 ,52.63, 51.02 , 52.09 , 51.02 ,Current Medicare Rates,52.09,51.55,Included in per diem,51.02,Included in ER Case rate,51.02,51.02, 52.63 ,48.33
Rx59676031001,RX,J0885,59676031001,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),EPOETIN ALFA INJ 10000 UNIT/ML,1,583.66, 554.48 ,571.99, 554.48 , 566.15 , 554.48 ,Current Medicare Rates,566.15,560.31,Included in per diem,554.48,Included in ER Case rate,554.48,554.48, 571.99 ,525.294
Rx00046074905,RX,J1410,00046074905,0636 - PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A),"ESTROGENS, CONJUGATED FOR INJ 25 MG",1,1012.01, 961.41 ,991.77, 961.41 , 981.65 , 961.41 ,Current Medicare Rates,981.65,971.53,Included in per diem,961.41,Included in ER Case rate,961.41,961.41, 991.77 ,910.809
65510001,EAP,Custom 65510001,,0655 - HOSPICE SERVICE - INPATIENT RESPITE CARE,Hc R&b Hospice Respite,1,261, 247.95 ,255.78, 247.95 , 253.17 , 247.95 ,Current Medicare Rates,253.17,250.56,Included in per diem,247.95,Included in ER Case rate,247.95,247.95, 255.78 ,234.9
68310001,EAP,CPT® G0390,,0683 - TRAUMA RESPONSE - LEVEL III TRAUMA,Hc Ed Trauma Response With Critical Care Full G0390 Cdm,1,2240," 2,128.00 ",2195.2," 2,128.00 "," 2,172.80 "," 2,128.00 ",Current Medicare Rates,2172.8,2150.4,Included in per diem,2128,Included in ER Case rate,2128,2128," 2,195.20 ",2016
71010231,EAP,Custom 71010231,,0710 - RECOVERY ROOM - GENERAL CLASSIFICATION,Hc Pacu Recover Surg Level 1 Per Min,1,12, 11.40 ,11.76, 11.40 , 11.64 , 11.40 ,Current Medicare Rates,11.64,11.52,Included in per diem,11.4,Included in ER Case rate,11.4,11.4, 11.76 ,10.8
71010232,EAP,Custom 71010232,,0710 - RECOVERY ROOM - GENERAL CLASSIFICATION,Hc Pacu Recover Surg Level 2 Per Min,1,12, 11.40 ,11.76, 11.40 , 11.64 , 11.40 ,Current Medicare Rates,11.64,11.52,Included in per diem,11.4,Included in ER Case rate,11.4,11.4, 11.76 ,10.8
71010233,EAP,Custom 71010233,,0710 - RECOVERY ROOM - GENERAL CLASSIFICATION,Hc Pacu Recover Surg Level 3 Per Min,1,12, 11.40 ,11.76, 11.40 , 11.64 , 11.40 ,Current Medicare Rates,11.64,11.52,Included in per diem,11.4,Included in ER Case rate,11.4,11.4, 11.76 ,10.8
71010234,EAP,Custom 71010234,,0710 - RECOVERY ROOM - GENERAL CLASSIFICATION,Hc Pacu Recover Surg Level 4 Per Min,1,12, 11.40 ,11.76, 11.40 , 11.64 , 11.40 ,Current Medicare Rates,11.64,11.52,Included in per diem,11.4,Included in ER Case rate,11.4,11.4, 11.76 ,10.8
71010358,EAP,Custom 71010358,,0710 - RECOVERY ROOM - GENERAL CLASSIFICATION,Hc Pacu Recover Surg Level 5 Per Min,1,11, 10.45 ,10.78, 10.45 , 10.67 , 10.45 ,Current Medicare Rates,10.67,10.56,Included in per diem,10.45,Included in ER Case rate,10.45,10.45, 10.78 ,9.9
71010243,EAP,Custom 71010243,,0710 - RECOVERY ROOM - GENERAL CLASSIFICATION,Hc Pc Phase Ii Recovery Level 1,1,142, 134.90 ,139.16, 134.90 , 137.74 , 134.90 ,Current Medicare Rates,137.74,136.32,Included in per diem,134.9,Included in ER Case rate,134.9,134.9, 139.16 ,127.8
71010244,EAP,Custom 71010244,,0710 - RECOVERY ROOM - GENERAL CLASSIFICATION,Hc Pc Phase Ii Recovery Level 2,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,Included in per diem,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
72010073,EAP,Custom 72010073,,0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION,Hc Ante Acuity Per Hr Class 3,1,235, 223.25 ,230.3, 223.25 , 227.95 , 223.25 ,Current Medicare Rates,227.95,225.6,Included in per diem,223.25,Included in ER Case rate,223.25,223.25, 230.30 ,211.5
72010070,EAP,Custom 72010070,,0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION,Hc Ante Acuity Per Hr Class Ii,1,213, 202.35 ,208.74, 202.35 , 206.61 , 202.35 ,Current Medicare Rates,206.61,204.48,Included in per diem,202.35,Included in ER Case rate,202.35,202.35, 208.74 ,191.7
72010068,EAP,Custom 72010068,,0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION,Hc Intra Acuity Per Hr Class 1,1,188, 178.60 ,184.24, 178.60 , 182.36 , 178.60 ,Current Medicare Rates,182.36,180.48,Included in per diem,178.6,Included in ER Case rate,178.6,178.6, 184.24 ,169.2
72010071,EAP,Custom 72010071,,0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION,Hc Intra Acuity Per Hr Class 2,1,195, 185.25 ,191.1, 185.25 , 189.15 , 185.25 ,Current Medicare Rates,189.15,187.2,Included in per diem,185.25,Included in ER Case rate,185.25,185.25, 191.10 ,175.5
72010074,EAP,Custom 72010074,,0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION,Hc Intra Acuity Per Hr Class 3,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,Included in per diem,190,Included in ER Case rate,190,190, 196.00 ,180
72010077,EAP,Custom 72010077,,0720 - LABOR ROOM/DELIVERY - GENERAL CLASSIFICATION,Hc Intra Acuity Per Hr Class 4,1,204, 193.80 ,199.92, 193.80 , 197.88 , 193.80 ,Current Medicare Rates,197.88,195.84,Included in per diem,193.8,Included in ER Case rate,193.8,193.8, 199.92 ,183.6
72210001,EAP,Custom 72210001,,0722 - LABOR ROOM/DELIVERY - DELIVERY ROOM,Hc Delivery Level 1,1,1390," 1,320.50 ",1362.2," 1,320.50 "," 1,348.30 "," 1,320.50 ",Current Medicare Rates,1348.3,1334.4,Included in per diem,1320.5,Included in ER Case rate,1320.5,1320.5," 1,362.20 ",1251
72210002,EAP,Custom 72210002,,0722 - LABOR ROOM/DELIVERY - DELIVERY ROOM,Hc Delivery Level 2,1,1905," 1,809.75 ",1866.9," 1,809.75 "," 1,847.85 "," 1,809.75 ",Current Medicare Rates,1847.85,1828.8,Included in per diem,1809.75,Included in ER Case rate,1809.75,1809.75," 1,866.90 ",1714.5
72310001,EAP,CPT® 54150,,0723 - LABOR ROOM/DELIVERY - CIRCUMCISION,Hc Circumcision W/regionl Block,1,272, 258.40 ,266.56, 258.40 , 263.84 , 258.40 ,Current Medicare Rates,263.84,261.12,Included in per diem,258.4,Included in ER Case rate,258.4,258.4, 266.56 ,244.8
73010002,EAP,CPT® 93005,,0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION,Hc Ecg 12 Lead Tracing Only,1,245, 232.75 ,240.1, 232.75 , 237.65 , 232.75 ,Current Medicare Rates,237.65,235.2,Included in per diem,232.75,Included in ER Case rate,232.75,232.75, 240.10 ,220.5
73010003,EAP,CPT® 93041,,0730 - EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION,Hc Rhythm Ecg Tracing Only,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,Included in per diem,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
73100003,EAP,93242,,0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR,HC EXTERNAL ECG REC>48HR<7D RECORDING CDM,1,449, 426.55 ,440.02, 426.55 , 435.53 , 426.55 ,Current Medicare Rates,435.53,431.04,Included in per diem,426.55,Included in ER Case rate,426.55,426.55, 440.02 ,404.1
73100004,EAP,93243,,0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR,HC EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT CDM,1,449, 426.55 ,440.02, 426.55 , 435.53 , 426.55 ,Current Medicare Rates,435.53,431.04,Included in per diem,426.55,Included in ER Case rate,426.55,426.55, 440.02 ,404.1
73100001,EAP,93246,,0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR,HC EXTERNAL ECG REC>7D<15D RECORDING CDM,1,449, 426.55 ,440.02, 426.55 , 435.53 , 426.55 ,Current Medicare Rates,435.53,431.04,Included in per diem,426.55,Included in ER Case rate,426.55,426.55, 440.02 ,404.1
73100002,EAP,93247,,0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR,HC EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT CDM,1,471, 447.45 ,461.58, 447.45 , 456.87 , 447.45 ,Current Medicare Rates,456.87,452.16,Included in per diem,447.45,Included in ER Case rate,447.45,447.45, 461.58 ,423.9
73110002,EAP,CPT® 93226,,0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR,Hc Holter Monitor Analysis & Rept,1,471, 447.45 ,461.58, 447.45 , 456.87 , 447.45 ,Current Medicare Rates,456.87,452.16,Included in per diem,447.45,Included in ER Case rate,447.45,447.45, 461.58 ,423.9
73110001,EAP,CPT® 93225,,0731 - EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR,Hc Holter Monitor Up To 48 Hrs,1,490, 465.50 ,480.2, 465.50 , 475.30 , 465.50 ,Current Medicare Rates,475.3,470.4,Included in per diem,465.5,Included in ER Case rate,465.5,465.5, 480.20 ,441
73210002,EAP,CPT® 93271,,0732 - EKG/ECG (ELECTROCARDIOGRAM) - TELEMETRY,Hc Cardiac Event Dwnld & Analysis,1,286, 271.70 ,280.28, 271.70 , 277.42 , 271.70 ,Current Medicare Rates,277.42,274.56,Included in per diem,271.7,Included in ER Case rate,271.7,271.7, 280.28 ,257.4
73210001,EAP,CPT® 93270,,0732 - EKG/ECG (ELECTROCARDIOGRAM) - TELEMETRY,Hc Cardiac Event Monitor Set Up,1,325, 308.75 ,318.5, 308.75 , 315.25 , 308.75 ,Current Medicare Rates,315.25,312,Included in per diem,308.75,Included in ER Case rate,308.75,308.75, 318.50 ,292.5
75010048,EAP,Custom 75010048,,0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION,Hc Gastric Lavage,1,217, 206.15 ,212.66, 206.15 , 210.49 , 206.15 ,Current Medicare Rates,210.49,208.32,Included in per diem,206.15,Included in ER Case rate,206.15,206.15, 212.66 ,195.3
75010118,EAP,Custom 75010118,,0750 - GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION,Hc Sigmoidoscopy W/ Snare Removal,1,1066," 1,012.70 ",1044.68," 1,012.70 "," 1,034.02 "," 1,012.70 ",Current Medicare Rates,1034.02,1023.36,Included in per diem,1012.7,Included in ER Case rate,1012.7,1012.7," 1,044.68 ",959.4
76110006,EAP,CPT® 99211,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Estab Pt Visit - Level 1,1,88, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,Included in per diem,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
76110039,EAP,CPT® 99212,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Estab Pt Visit - Level 2,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,Included in per diem,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
76110040,EAP,CPT® 99213,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,HC ESTAB PT VISIT - LEVEL 3,1,183, 173.85 ,179.34, 173.85 , 177.51 , 173.85 ,Current Medicare Rates,177.51,175.68,Included in per diem,173.85,Included in ER Case rate,173.85,173.85, 179.34 ,164.7
76110041,EAP,CPT® 99214,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Estab Pt Visit - Level 4,1,282, 267.90 ,276.36, 267.90 , 273.54 , 267.90 ,Current Medicare Rates,273.54,270.72,Included in per diem,267.9,Included in ER Case rate,267.9,267.9, 276.36 ,253.8
76110021,EAP,CPT® 99215,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Estab Pt Visit - Level 5,1,417, 396.15 ,408.66, 396.15 , 404.49 , 396.15 ,Current Medicare Rates,404.49,400.32,Included in per diem,396.15,Included in ER Case rate,396.15,396.15, 408.66 ,375.3
76110307,EAP,CPT® 96523,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Irrig Drug Delivery Device^,1,237, 225.15 ,232.26, 225.15 , 229.89 , 225.15 ,Current Medicare Rates,229.89,227.52,Included in per diem,225.15,Included in ER Case rate,225.15,225.15, 232.26 ,213.3
76110507,EAP,CPT® 99211,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc L&d Triage Lvl 1,1,84, 79.80 ,82.32, 79.80 , 81.48 , 79.80 ,Current Medicare Rates,81.48,80.64,Included in per diem,79.8,Included in ER Case rate,79.8,79.8, 82.32 ,75.6
76110533,EAP,CPT® 99213,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc L&d Triage Lvl 3,1,212, 201.40 ,207.76, 201.40 , 205.64 , 201.40 ,Current Medicare Rates,205.64,203.52,Included in per diem,201.4,Included in ER Case rate,201.4,201.4, 207.76 ,190.8
76110534,EAP,CPT® 99214,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc L&d Triage Lvl 4,1,271, 257.45 ,265.58, 257.45 , 262.87 , 257.45 ,Current Medicare Rates,262.87,260.16,Included in per diem,257.45,Included in ER Case rate,257.45,257.45, 265.58 ,243.9
94210100,EAP,CPT® 99211,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Lactation Consult < 30,1,83, 78.85 ,81.34, 78.85 , 80.51 , 78.85 ,Current Medicare Rates,80.51,79.68,Included in per diem,78.85,Included in ER Case rate,78.85,78.85, 81.34 ,74.7
94210105,EAP,CPT® 99211,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Lactation Consult 30 Min,1,61, 57.95 ,59.78, 57.95 , 59.17 , 57.95 ,Current Medicare Rates,59.17,58.56,Included in per diem,57.95,Included in ER Case rate,57.95,57.95, 59.78 ,54.9
94210108,EAP,CPT® 99211,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc Lactation Consult Lvl 1,1,82, 77.90 ,80.36, 77.90 , 79.54 , 77.90 ,Current Medicare Rates,79.54,78.72,Included in per diem,77.9,Included in ER Case rate,77.9,77.9, 80.36 ,73.8
76110002,EAP,99202,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,HC NEW PT VISIT - LEVEL 2,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
76110002,EAP,99202,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,HC NEW PT VISIT - LEVEL 2,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
76110002,EAP,99202,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,HC NEW PT VISIT - LEVEL 2,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
76110002,EAP,99202,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,HC NEW PT VISIT - LEVEL 2,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
76110002,EAP,99202,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,HC NEW PT VISIT - LEVEL 2,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,Included in per diem,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
76110003,EAP,CPT® 99203,,0761 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM,Hc New Pt Visit - Level 3,1,255, 242.25 ,249.9, 242.25 , 247.35 , 242.25 ,Current Medicare Rates,247.35,244.8,Included in per diem,242.25,Included in ER Case rate,242.25,242.25, 249.90 ,229.5
76210001,EAP,HCPCS G0378,,0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A),Hc Initial Observ/low Cmplx,1,0, -   ,0, -   , -   , -   ,Current Medicare Rates,0,0,Included in per diem,0,Included in ER Case rate,0,0, -   ,0
76210005,EAP,HCPCS G0378,,0762 - SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - OBSERVATION ROOM (A),Hc Initial Observ/mod Cmplx,1,0, -   ,0, -   , -   , -   ,Current Medicare Rates,0,0,Included in per diem,0,Included in ER Case rate,0,0, -   ,0
77110005,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Admin Hepatitis B Vaccine,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
77110003,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Admin Influenza Virus Vac,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,Included in per diem,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
77110004,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Admin Pneumococcal Vaccine,1,74, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,Included in per diem,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
77100007,EAP,0031A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION JANSSEN ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100007,EAP,0031A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION JANSSEN ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100018,EAP,0034A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION JANSSEN BOOSTER ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100003,EAP,0011A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 1ST ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100003,EAP,0011A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 1ST ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100003,EAP,0011A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 1ST ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100003,EAP,0011A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 1ST ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100004,EAP,0012A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 2ND ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100004,EAP,0012A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 2ND ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100004,EAP,0012A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 2ND ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100004,EAP,0012A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 2ND ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100009,EAP,0013A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA 3RD ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100015,EAP,0064A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION MODERNA BOOSTER ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100001,EAP,0001A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER 1ST ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100002,EAP,0002A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER 2ND ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100002,EAP,0002A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER 2ND ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100002,EAP,0002A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER 2ND ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100002,EAP,0002A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER 2ND ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100008,EAP,0003A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER 3RD ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100010,EAP,0004A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER BOOSTER ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100016,EAP,0071A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER PEDIATRIC 1ST ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100017,EAP,0072A,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,HC COVID 19 IMMUNIZATION PFIZER PEDIATRIC 2ND ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77110001,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Immunization Admin,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,Included in per diem,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
77110002,EAP,CPT® 90472,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Immunization Admin Each Add,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
96910463,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr 90471 Immunization Admin,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,Included in per diem,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
96910338,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr 90471 Vfc Immunization Admin Initial,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
96910464,EAP,CPT® 90472,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr 90472 Immunization Admin Each Add,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
96910339,EAP,CPT® 90472,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr 90472 Vfc Immunization Admin Each Addl,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
77110226,EAP,CPT® 90472,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Ea Addl,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,Included in per diem,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
77110230,EAP,CPT® 90472,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Ea Addl Vfc,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
77110235,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Hepatis B,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77110233,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Influenza,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
77110225,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Initial,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77110227,EAP,CPT® 90473,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Initial Intranasal/oral,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77110228,EAP,CPT® 90474,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Initial Intranasal/oral Ea Addl,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,Included in per diem,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77110232,EAP,CPT® 90474,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Initial Intranasal/oral Ea Addl Vfc,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
77110231,EAP,CPT® 90473,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Initial Intranasal/oral Vfc,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
77110229,EAP,CPT® 90471,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr Admin Vaccine Initial Vfc,1,0.01, 0.01 ,0.01, 0.01 , 0.01 , 0.01 ,Current Medicare Rates,0.01,0.01,Included in per diem,0.01,Included in ER Case rate,0.01,0.01, 0.01 ,0.009
96910343,EAP,HCPCS G0008,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr G0008 Medicare Admin Influenza Virus Vac,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
96910344,EAP,HCPCS G0009,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr G0009 Medicare Admin Pneumococcal Vaccine,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,Included in per diem,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
96910483,EAP,HCPCS G0010,,0771 - PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION,Hc Pr G0010 Medicare Admin Hepatitis B Vaccine,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,Included in per diem,57,Included in ER Case rate,57,57, 58.80 ,54
90010044,EAP,CPT® 90834,,0900 - BH TREATMENT/SERVICES - GENERAL CLASSIFICATION,HC PSYCHOTHERAPY PATIENT &/ FAMILY 45 MINUTES,1,299, 284.05 ,293.02, 284.05 , 290.03 , 284.05 ,Current Medicare Rates,290.03,287.04,Included in per diem,284.05,Included in ER Case rate,284.05,284.05, 293.02 ,269.1
91410052,EAP,CPT® 90832,,0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY,Hc Crisis Phone 90832 Psychotherapy W/pt 30 Min Cdm,1,152, 144.40 ,148.96, 144.40 , 147.44 , 144.40 ,Current Medicare Rates,147.44,145.92,Included in per diem,144.4,Included in ER Case rate,144.4,144.4, 148.96 ,136.8
91410053,EAP,CPT® 90834,,0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY,Hc Crisis Phone 90834 Psychotherapy W/pt 45 Min Cdm,1,299, 284.05 ,293.02, 284.05 , 290.03 , 284.05 ,Current Medicare Rates,290.03,287.04,Included in per diem,284.05,Included in ER Case rate,284.05,284.05, 293.02 ,269.1
91410054,EAP,CPT® 90837,,0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY,Hc Crisis Phone 90837 Psychotherapy W/pt 60 Min Cdm,1,303, 287.85 ,296.94, 287.85 , 293.91 , 287.85 ,Current Medicare Rates,293.91,290.88,Included in per diem,287.85,Included in ER Case rate,287.85,287.85, 296.94 ,272.7
91410110,EAP,CPT® 90791,,0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY,Hc Mental Health Assessment N/md,1,309, 293.55 ,302.82, 293.55 , 299.73 , 293.55 ,Current Medicare Rates,299.73,296.64,Included in per diem,293.55,Included in ER Case rate,293.55,293.55, 302.82 ,278.1
91410111,EAP,CPT® 90837,,0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY,"Hc Psychotherapy,individ 1 Hour",1,303, 287.85 ,296.94, 287.85 , 293.91 , 287.85 ,Current Medicare Rates,293.91,290.88,Included in per diem,287.85,Included in ER Case rate,287.85,287.85, 296.94 ,272.7
91410113,EAP,CPT® 90832,,0914 - BEHAVIORAL HEALTH TREATMENTS/SERVICES - INDIVIDUAL THERAPY,Hc Ther Bh Svc Ind <18-30 Min,1,152, 144.40 ,148.96, 144.40 , 147.44 , 144.40 ,Current Medicare Rates,147.44,145.92,Included in per diem,144.4,Included in ER Case rate,144.4,144.4, 148.96 ,136.8
92010032,EAP,CPT® 59025,,0920 - OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION,Hc Fetal Non-stress Test,1,940, 893.00 ,921.2, 893.00 , 911.80 , 893.00 ,Current Medicare Rates,911.8,902.4,Included in per diem,893,Included in ER Case rate,893,893, 921.20 ,846
92110017,EAP,CPT® 93975,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Duplex study abd/pel/scrotal/rtroperitnl complete,1,800, 760.00 ,784, 760.00 , 776.00 , 760.00 ,Current Medicare Rates,776,768,Included in per diem,760,Included in ER Case rate,760,760, 784.00 ,720
92110018,EAP,CPT® 93976,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Duplex study abd/pel/scrotal/rtroperitnl ltd,1,439, 417.05 ,430.22, 417.05 , 425.83 , 417.05 ,Current Medicare Rates,425.83,421.44,Included in per diem,417.05,Included in ER Case rate,417.05,417.05, 430.22 ,395.1
92110024,EAP,CPT® 93990,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Doppler Flow Testing,1,446, 423.70 ,437.08, 423.70 , 432.62 , 423.70 ,Current Medicare Rates,432.62,428.16,Included in per diem,423.7,Included in ER Case rate,423.7,423.7, 437.08 ,401.4
92110002,EAP,CPT® 93880,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Duplex Extracranial Study Bilat,1,955, 907.25 ,935.9, 907.25 , 926.35 , 907.25 ,Current Medicare Rates,926.35,916.8,Included in per diem,907.25,Included in ER Case rate,907.25,907.25, 935.90 ,859.5
92110003,EAP,CPT® 93882,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Duplex Extracranial Study Unilat,1,604, 573.80 ,591.92, 573.80 , 585.88 , 573.80 ,Current Medicare Rates,585.88,579.84,Included in per diem,573.8,Included in ER Case rate,573.8,573.8, 591.92 ,543.6
92110016,EAP,CPT® 93971,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Extremity Study Venous Duplex,1,689, 654.55 ,675.22, 654.55 , 668.33 , 654.55 ,Current Medicare Rates,668.33,661.44,Included in per diem,654.55,Included in ER Case rate,654.55,654.55, 675.22 ,620.1
92110015,EAP,CPT® 93970,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Extremity Study Venous Duplex Bilat,1,921, 874.95 ,902.58, 874.95 , 893.37 , 874.95 ,Current Medicare Rates,893.37,884.16,Included in per diem,874.95,Included in ER Case rate,874.95,874.95, 902.58 ,828.9
92110009,EAP,CPT® 93924,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Lower Extr Vasc Study Bilat W/treadmill Stress Testing,1,675, 641.25 ,661.5, 641.25 , 654.75 , 641.25 ,Current Medicare Rates,654.75,648,Included in per diem,641.25,Included in ER Case rate,641.25,641.25, 661.50 ,607.5
92110011,EAP,CPT® 93926,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Lower Extremity Study Duplex,1,644, 611.80 ,631.12, 611.80 , 624.68 , 611.80 ,Current Medicare Rates,624.68,618.24,Included in per diem,611.8,Included in ER Case rate,611.8,611.8, 631.12 ,579.6
92110010,EAP,CPT® 93925,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Lower Extremity Study Duplex Bilat,1,1092," 1,037.40 ",1070.16," 1,037.40 "," 1,059.24 "," 1,037.40 ",Current Medicare Rates,1059.24,1048.32,Included in per diem,1037.4,Included in ER Case rate,1037.4,1037.4," 1,070.16 ",982.8
92110028,EAP,CPT® 93922,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Physio Ue/le Art 2 Lvls,1,488, 463.60 ,478.24, 463.60 , 473.36 , 463.60 ,Current Medicare Rates,473.36,468.48,Included in per diem,463.6,Included in ER Case rate,463.6,463.6, 478.24 ,439.2
92110013,EAP,CPT® 93931,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Upper Extremity Study Duplex,1,500, 475.00 ,490, 475.00 , 485.00 , 475.00 ,Current Medicare Rates,485,480,Included in per diem,475,Included in ER Case rate,475,475, 490.00 ,450
92110012,EAP,CPT® 93930,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Upper Extremity Study Duplex Bilat,1,699, 664.05 ,685.02, 664.05 , 678.03 , 664.05 ,Current Medicare Rates,678.03,671.04,Included in per diem,664.05,Included in ER Case rate,664.05,664.05, 685.02 ,629.1
92110019,EAP,CPT® 93978,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Vascular Study Aorta/ivc/iliac Complete,1,750, 712.50 ,735, 712.50 , 727.50 , 712.50 ,Current Medicare Rates,727.5,720,Included in per diem,712.5,Included in ER Case rate,712.5,712.5, 735.00 ,675
92110020,EAP,CPT® 93979,,0921 - OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB,Hc Vascular Study Aorta/ivc/iliac Limited,1,695, 660.25 ,681.1, 660.25 , 674.15 , 660.25 ,Current Medicare Rates,674.15,667.2,Included in per diem,660.25,Included in ER Case rate,660.25,660.25, 681.10 ,625.5
94010050,EAP,CPT® 51701,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,Hc Insert Bladder Catheter,1,245, 232.75 ,240.1, 232.75 , 237.65 , 232.75 ,Current Medicare Rates,237.65,235.2,Included in per diem,232.75,Included in ER Case rate,232.75,232.75, 240.10 ,220.5
94010051,EAP,CPT® 51702,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,Hc Insert Temp Bladder Cath,1,271, 257.45 ,265.58, 257.45 , 262.87 , 257.45 ,Current Medicare Rates,262.87,260.16,Included in per diem,257.45,Included in ER Case rate,257.45,257.45, 265.58 ,243.9
94010204,EAP,CPT® 99195,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,Hc Phlebotomy,1,135, 128.25 ,132.3, 128.25 , 130.95 , 128.25 ,Current Medicare Rates,130.95,129.6,Included in per diem,128.25,Included in ER Case rate,128.25,128.25, 132.30 ,121.5
96910474,EAP,CPT® 96372,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,Hc Pr 96372 Ther/proph/diag Inj Sc/im,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,Included in per diem,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
94010207,EAP,CPT® 96374,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,HC THER/PROPH/DIAG IV PUSH^,1,205, 194.75 ,200.9, 194.75 , 198.85 , 194.75 ,Current Medicare Rates,198.85,196.8,Included in per diem,194.75,Included in ER Case rate,194.75,194.75, 200.90 ,184.5
94010208,EAP,CPT® 96375,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,HC TX/PRO/DX IV PUSH NEW DRUG ADDON^,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,Included in per diem,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
94010209,EAP,CPT® 96376,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,Hc Tx/pro/dx Iv Push Same Drug Add On Cdm,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,Included in per diem,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
94010052,EAP,Custom 94010052,,0940 - OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION,HC Ultraviolet light therapy,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,Included in per diem,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
94010003,EAP,CPT® 99406,,0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING,Hc Behav Chng Smoking 3-10 Min,1,52, 49.40 ,50.96, 49.40 , 50.44 , 49.40 ,Current Medicare Rates,50.44,49.92,Included in per diem,49.4,Included in ER Case rate,49.4,49.4, 50.96 ,46.8
94210013,EAP,CPT® 97803,,0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING,Hc Med Nutrition Indiv Subseq Ea 15 Min,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
94210049,EAP,CPT® 97804,,0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING,Hc Medical Nutrition Group Ea 30 Min,1,41, 38.95 ,40.18, 38.95 , 39.77 , 38.95 ,Current Medicare Rates,39.77,39.36,Included in per diem,38.95,Included in ER Case rate,38.95,38.95, 40.18 ,36.9
94210001,EAP,CPT® 97802,,0942 - OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING,Hc Medical Nutrition Indiv Init Ea 15 Min,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,Included in per diem,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
96010104,EAP,97810,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97810 ACUPUNCT W/O ELEC STIMUL 15 MIN,1,102, 96.90 ,60.06, 96.90 , 60.97 , 60.97 ,Current Medicare Rates,98.94,97.92,N/A,96.9,Included in ER Case rate,96.9,60.06, 98.94 ,91.8
96010104,EAP,97810,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97810 ACUPUNCT W/O ELEC STIMUL 15 MIN,1,102, 96.90 ,60.06, 96.90 , 60.97 , 60.97 ,Current Medicare Rates,98.94,97.92,N/A,96.9,Included in ER Case rate,96.9,60.06, 98.94 ,91.8
96010104,EAP,97810,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97810 ACUPUNCT W/O ELEC STIMUL 15 MIN,1,102, 96.90 ,60.06, 96.90 , 60.97 , 60.97 ,Current Medicare Rates,98.94,97.92,N/A,96.9,Included in ER Case rate,96.9,60.06, 98.94 ,91.8
96010105,EAP,97811,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97811 ACUPUNCT W/O ELEC STIMUL ADDL 15M,1,85, 80.75 ,50.82, 80.75 , 51.59 , 51.59 ,Current Medicare Rates,82.45,81.6,N/A,80.75,Included in ER Case rate,80.75,50.82, 82.45 ,76.5
96010105,EAP,97811,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97811 ACUPUNCT W/O ELEC STIMUL ADDL 15M,1,85, 80.75 ,50.82, 80.75 , 51.59 , 51.59 ,Current Medicare Rates,82.45,81.6,N/A,80.75,Included in ER Case rate,80.75,50.82, 82.45 ,76.5
96010105,EAP,97811,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97811 ACUPUNCT W/O ELEC STIMUL ADDL 15M,1,85, 80.75 ,50.82, 80.75 , 51.59 , 51.59 ,Current Medicare Rates,82.45,81.6,N/A,80.75,Included in ER Case rate,80.75,50.82, 82.45 ,76.5
96010106,EAP,97813,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97813 ACUPUNCT W/ ELEC STIMUL 15 MIN,1,112, 106.40 ,65.34, 106.40 , 66.33 , 66.33 ,Current Medicare Rates,108.64,107.52,N/A,106.4,Included in ER Case rate,106.4,65.34, 108.64 ,100.8
96010106,EAP,97813,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97813 ACUPUNCT W/ ELEC STIMUL 15 MIN,1,112, 106.40 ,65.34, 106.40 , 66.33 , 66.33 ,Current Medicare Rates,108.64,107.52,N/A,106.4,Included in ER Case rate,106.4,65.34, 108.64 ,100.8
96010106,EAP,97813,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97813 ACUPUNCT W/ ELEC STIMUL 15 MIN,1,112, 106.40 ,65.34, 106.40 , 66.33 , 66.33 ,Current Medicare Rates,108.64,107.52,N/A,106.4,Included in ER Case rate,106.4,65.34, 108.64 ,100.8
96010107,EAP,97814,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97814 ACUPUNCT W/ ELEC STIMUL ADDL 15M,1,95, 90.25 ,55.44, 90.25 , 56.28 , 56.28 ,Current Medicare Rates,92.15,91.2,N/A,90.25,Included in ER Case rate,90.25,55.44, 92.15 ,85.5
96010107,EAP,97814,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97814 ACUPUNCT W/ ELEC STIMUL ADDL 15M,1,95, 90.25 ,55.44, 90.25 , 56.28 , 56.28 ,Current Medicare Rates,92.15,91.2,N/A,90.25,Included in ER Case rate,90.25,55.44, 92.15 ,85.5
96010107,EAP,97814,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,HC PR 97814 ACUPUNCT W/ ELEC STIMUL ADDL 15M,1,95, 90.25 ,55.44, 90.25 , 56.28 , 56.28 ,Current Medicare Rates,92.15,91.2,N/A,90.25,Included in ER Case rate,90.25,55.44, 92.15 ,85.5
96010015,EAP,CPT® 99406,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,BEHAV CHNG SMOKING 3-10 MIN,1,52, 49.40 ,23.1, 49.40 , 23.45 , 23.45 ,Current Medicare Rates,50.44,49.92,N/A,49.4,Included in ER Case rate,49.4,23.1, 50.44 ,46.8
97210013,EAP,CPT® 76872,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 76872 Us Transrectal,1,288, 273.60 ,397.98, 273.60 , 404.01 , 404.01 ,Current Medicare Rates,279.36,276.48,N/A,273.6,Included in ER Case rate,273.6,273.6, 404.01 ,259.2
96010044,EAP,CPT® 95018,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 95018 Allg Test Perq & Ic Drug/biol Immed React W/ I&r,1,71, 67.45 ,13.86, 67.45 , 14.07 , 14.07 ,Current Medicare Rates,68.87,68.16,N/A,67.45,Included in ER Case rate,67.45,13.86, 68.87 ,63.9
96010045,EAP,CPT® 95076,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 95076 Ingestion Challenge Test Initial 120 Minutes,1,391, 371.45 ,143.22, 371.45 , 145.39 , 145.39 ,Current Medicare Rates,379.27,375.36,N/A,371.45,Included in ER Case rate,371.45,143.22, 379.27 ,351.9
96010046,EAP,CPT® 95079,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 95079 Ingestion Challenge Test Each Addl 60 Minutes,1,294, 279.30 ,132, 279.30 , 134.00 , 134.00 ,Current Medicare Rates,285.18,282.24,N/A,279.3,Included in ER Case rate,279.3,132, 285.18 ,264.6
96010017,EAP,CPT® 99407,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 99407 Behav Chng Smoking > 10 Min,1,100, 95.00 ,48.84, 95.00 , 49.58 , 49.58 ,Current Medicare Rates,97,96,N/A,95,Included in ER Case rate,95,48.84, 97.00 ,90
96010066,EAP,CPT® 99487,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 99487 Cmplx Chron Care Mgmt W/o Pt Vst 1st Hr Per Mo,1,329, 312.55 ,176.88, 312.55 , 179.56 , 179.56 ,Current Medicare Rates,319.13,315.84,N/A,312.55,Included in ER Case rate,312.55,176.88, 319.13 ,296.1
96010067,EAP,CPT® 99489,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 99489 Cmplx Chron Care Mgmt Ea Addl 30 Min Per Month,1,158, 150.10 ,97.68, 150.10 , 99.16 , 99.16 ,Current Medicare Rates,153.26,151.68,N/A,150.1,Included in ER Case rate,150.1,97.68, 153.26 ,142.2
96010047,EAP,CPT® 99495,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 99495 Transitional Care Manage Service 14 Day Dischrge,1,403, 382.85 ,272.58, 382.85 , 276.71 , 276.71 ,Current Medicare Rates,390.91,386.88,N/A,382.85,Included in ER Case rate,382.85,272.58, 390.91 ,362.7
96010048,EAP,CPT® 99496,,0960 - PROFESSIONAL FEES - GENERAL CLASSIFICATION,Hc Pr 99496 Transitional Care Manage Service 7 Day Discharge,1,595, 565.25 ,371.58, 565.25 , 377.21 , 377.21 ,Current Medicare Rates,577.15,571.2,N/A,565.25,Included in ER Case rate,565.25,371.58, 577.15 ,535.5
96310014,EAP,00160,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),HC PR 00160 ANESTHESIA NOSE & ACCESSORY SINUSES NOS^,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310039,EAP,00520,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),HC PR 00520 ANESTH CHEST PROCEDURE,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310116,EAP,01214,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),HC PR 01214 ANESTH HIP ARTHROPLASTY,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310232,EAP,36569,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),HC PR 36569 INSERTION PICC W/O IMG GDN 5 YR/>,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310024,EAP,ASA 00320,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),ANESTH NECK ORGAN 1 & OVER,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310060,EAP,ASA 00752,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),ANESTH REPAIR OF HERNIA VENTRIL &INCISION,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310009,EAP,ASA 00142,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00142 Anesth Lens Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310017,EAP,Custom 00170,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00170 Anesthesia Intraoral With Biopsy Nos^,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310023,EAP,ASA 00300,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00300 Anesth Head/neck/ptrunk,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310028,EAP,ASA 00400,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00400 Anesth Skin Ext/per/atrunk,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310029,EAP,ASA 00402,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00402 Anesth Surgery Of Breast,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310030,EAP,ASA 00404,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00404 Anesth Surgery Of Breast; Radical,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310031,EAP,ASA 00406,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00406 Anesth Surgery Of Breast; Rad Or Mod W/ Int Mam,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310032,EAP,ASA 00410,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00410 Anesth Correct Heart Rhythm,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310033,EAP,ASA 00450,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00450 Anesth Surgery Of Shoulder,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310041,EAP,ASA 00524,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00524 Anesth Chest Drainage,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310045,EAP,ASA 00532,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00532 Anesth Vascular Access,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310053,EAP,ASA 00635,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00635 Anesth Lumbar Puncture,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310055,EAP,ASA 00700,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00700 Anesth Abdominal Wall Surg,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310056,EAP,ASA 00702,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00702 Anesth For Liver Biopsy,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310057,EAP,ASA 00730,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00730 Anesth Abdominal Wall Surg,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310282,EAP,ASA 00731,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00731 Anes Uppr Gi Ndsc Px Nos,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310283,EAP,ASA 00732,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00732 Anes Upr Gi Ndsc Px Ercp,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310059,EAP,ASA 00750,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00750 Anesth Repair Of Upper Hernia,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310064,EAP,ASA 00790,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00790 Anesth Surg Upper Abdomen,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310068,EAP,ASA 00800,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00800 Anesth Abdominal Wall Surg,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310284,EAP,ASA 00811,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00811 Anes Lwr Intst Ndsc Nos,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310285,EAP,ASA 00812,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00812 Anes Lwr Intst Scr Colsc,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310286,EAP,ASA 00813,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00813 Anes Uppr Lwr Gi Ndsc Px,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310071,EAP,ASA 00820,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00820 Anesth Abdominal Wall Surg,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310072,EAP,ASA 00830,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00830 Anesth Repair Of Inguinal Hernia,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310073,EAP,ASA 00832,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00832 Anesth Repair Of Hernia Ventri&incision,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310075,EAP,ASA 00840,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00840 Anesth Surg Lower Abdomen,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310077,EAP,CPT® 00846,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00846 Anesth Hysterectomy,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310079,EAP,ASA 00851,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00851 Anesth Tubal Ligation,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310080,EAP,Custom 00860,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00860 Anesth Surgery Of Abdomen,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310089,EAP,ASA 00902,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00902 Anesth Anorectal Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310093,EAP,ASA 00910,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00910 Anesth Bladder Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310097,EAP,Custom 00918,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00918 Anesth Stone Removal,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310098,EAP,ASA 00920,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00920 Anesth Genitalia Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310099,EAP,ASA 00924,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00924 Anesth Testis Exploration,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310104,EAP,ASA 00940,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00940 Anesth Vaginal Procedures,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310105,EAP,ASA 00942,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 00942 Anesth Surg On Vag/urethral,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310110,EAP,ASA 01112,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01112 Anesth Bone Aspirate/bx,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310112,EAP,Custom 01200,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01200 Anesth Hip Joint Procedure,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,111.15,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
96310118,EAP,ASA 01220,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01220 Anesth Procedure On Femur,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310119,EAP,ASA 01230,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01230 Anesth Surgery Of Femur,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310122,EAP,ASA 01250,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01250 Anesth Upper Leg Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310123,EAP,ASA 01260,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01260 Anesth Upper Leg Veins Surg,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310127,EAP,ASA 01320,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01320 Anesth Knee Area Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310128,EAP,ASA 01340,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01340 Anesth Knee Area Procedure,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310129,EAP,ASA 01360,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01360 Anesth Knee Area Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310130,EAP,Custom 01380,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01380 Anesth Knee Joint Procedure,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310131,EAP,ASA 01382,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01382 Anesth Dx Knee Arthroscopy,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310133,EAP,ASA 01392,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01392 Anesth Knee Area Surgery Tib/fib/upper,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310134,EAP,ASA 01400,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01400 Anesth Knee Area Surgery Arthroscopy,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310142,EAP,ASA 01462,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01462 Anesth Lower Leg Procedure,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310144,EAP,ASA 01470,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01470 Anesth Lower Leg Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310146,EAP,ASA 01474,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01474 Anesth Lower Leg Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310147,EAP,ASA 01480,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01480 Anesth Lower Leg Bone Surg,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310148,EAP,ASA 01482,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01482 Anesth Radical Leg Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310154,EAP,ASA 01520,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01520 Anesth Lower Leg Vein Surg,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310156,EAP,ASA 01610,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01610 Anesth Surgery Of Shoulder And Axilla,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310157,EAP,ASA 01620,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01620 Anesth Shoulder Procedure,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310158,EAP,ASA 01622,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01622 Anes Dx Shoulder Arthroscopy,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310159,EAP,ASA 01630,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01630 Anesth Surgery Of Shoulder Open Or Surgical Arthro,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310165,EAP,ASA 01710,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01710 Anesth Elbow Area Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310169,EAP,ASA 01730,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01730 Anesth Uppr Arm Procedure,1,9.00, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310171,EAP,ASA 01740,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01740 Anesth Upper Arm Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310173,EAP,ASA 01744,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01744 Anesth Humerus Repair,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310179,EAP,ASA 01810,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01810 Anesth Lower Arm Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310180,EAP,ASA 01820,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01820 Anesth Lower Arm Procedure,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310182,EAP,ASA 01830,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01830 Anesth Lower Arm Surgery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310188,EAP,ASA 01860,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01860 Anesth Lower Arm Casting,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310190,EAP,ASA 01922,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01922 Anesth Cat Or Mri Scan,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310193,EAP,ASA 01958,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01958 Anesth Antepartum Manipul,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310194,EAP,ASA 01960,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01960 Anesth Vaginal Delivery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310195,EAP,ASA 01961,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01961 Anesth Cs Delivery,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310196,EAP,ASA 01962,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01962 Anesth Emer Hysterectomy,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310197,EAP,ASA 01963,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01963 Anesth Cs Hysterectomy,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310198,EAP,ASA 01965,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01965 Anesth Inc/missed Ab Proc,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310199,EAP,CPT® 01967,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01967 Anesth/analg Vag Delivery,1,9.00, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310200,EAP,ASA 01968,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01968 Anes/analg Cs Deliver Add-on,1,9.00, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310201,EAP,ASA 01969,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01969 Anesth/analg Cs Hyst Add-on,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310204,EAP,ASA 01992,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01992 Anesth N Block/inj Prone,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310205,EAP,CPT® 01996,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 01996 Hosp Manage Cont Drug Admin Aa,1,124, 117.80 ,121.52, 117.80 , 120.28 , 117.80 ,Current Medicare Rates,120.28,119.04,117.8,117.8,Included in ER Case rate,117.8,117.8, 121.52 ,111.6
96310220,EAP,CPT® 31500,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 31500 Intubation W/bronchoscope,1,701, 665.95 ,686.98, 665.95 , 679.97 , 665.95 ,Current Medicare Rates,679.97,672.96,665.95,665.95,Included in ER Case rate,665.95,665.95, 686.98 ,630.9
96310221,EAP,CPT® 36400,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 36400 Anes/venipuncture < Age 3,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310233,EAP,CPT® 36410,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 36410 Non-routine Bl Draw > 3 Yrs,1,93, 88.35 ,91.14, 88.35 , 90.21 , 88.35 ,Current Medicare Rates,90.21,89.28,88.35,88.35,Included in ER Case rate,88.35,88.35, 91.14 ,83.7
96310231,EAP,CPT® 36556,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 36556 Insert Non-tunnel Cv Cath > 5,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310223,EAP,CPT® 36620,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 36620 Anes/arterial Cath/cannula,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310224,EAP,CPT® 62270,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 62270 Anes/spinal Punc,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310267,EAP,CPT® 62320,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 62320 Inj Interlaminar Crv/thrc W/o Img,1,1150," 1,092.50 ",1127," 1,092.50 "," 1,115.50 "," 1,092.50 ",Current Medicare Rates,1115.5,1104,1092.5,1092.5,Included in ER Case rate,1092.5,1092.5," 1,127.00 ",1035
96310270,EAP,CPT® 62322,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 62322 Inj Interlaminar Lmbr/sac W/o Img,1,1095," 1,040.25 ",1073.1," 1,040.25 "," 1,062.15 "," 1,040.25 ",Current Medicare Rates,1062.15,1051.2,1040.25,1040.25,Included in ER Case rate,1040.25,1040.25," 1,073.10 ",985.5
96310243,EAP,CPT® 64415,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 64415 Nerve Block Inj Brachial Plexus,1,900, 855.00 ,882, 855.00 , 873.00 , 855.00 ,Current Medicare Rates,873,864,855,855,Included in ER Case rate,855,855, 882.00 ,810
96310238,EAP,CPT® 64447,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 64447 Nerve Block Inj Femoral Single,1,727, 690.65 ,712.46, 690.65 , 705.19 , 690.65 ,Current Medicare Rates,705.19,697.92,690.65,690.65,Included in ER Case rate,690.65,690.65, 712.46 ,654.3
96310215,EAP,CPT® 64450,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 64450 Nerve Block Other Peripheral Separate Proc,1,261, 247.95 ,255.78, 247.95 , 253.17 , 247.95 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,247.95, 255.78 ,234.9
96910983,EAP,CPT® 64488,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 64488 Tap Block Bilateral By Injection(s),1,233, 221.35 ,228.34, 221.35 , 226.01 , 221.35 ,Current Medicare Rates,226.01,223.68,221.35,221.35,Included in ER Case rate,221.35,221.35, 228.34 ,209.7
96310207,EAP,CPT® 99100,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 99100 Special Anesthesia Service,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,112.1,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
96310209,EAP,CPT® 99140,,0963 - PROFESSIONAL FEES - ANESTHESIOLOGIST (MD),Hc Pr 99140 Emergency Anesthesia,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96911020,EAP,CPT® 14350,,0969 - PROFESSIONAL FEES - OTHER PROFESSIONAL FEE,Hc Pr 14350 Filleted Finger/toe Flap,1,2534," 2,407.30 ",1326.6," 2,407.30 "," 1,346.70 "," 1,346.70 ",Current Medicare Rates,2457.98,2432.64,2407.3,2407.3,Included in ER Case rate,2407.3,1326.6," 2,457.98 ",2280.6
96910536,EAP,CPT® 20665,,0969 - PROFESSIONAL FEES - OTHER PROFESSIONAL FEE,Hc Pr 20665 Removal Of Fixation Device,1,553, 525.35 ,192.06, 525.35 , 194.97 , 194.97 ,Current Medicare Rates,536.41,530.88,525.35,525.35,Included in ER Case rate,525.35,192.06, 536.41 ,497.7
97210029,EAP,CPT® 76942,,0972 - PROFESSIONAL FEES - RADIOLOGY - DIAGNOSTIC,ECHO GUIDE FOR BIOPSY NEEDLE PLACEMENT,1,144, 136.80 ,114.84, 136.80 , 116.58 , 116.58 ,Current Medicare Rates,139.68,138.24,136.8,136.8,Included in ER Case rate,136.8,114.84, 139.68 ,129.6
97210018,EAP,CPT® 77001,,0972 - PROFESSIONAL FEES - RADIOLOGY - DIAGNOSTIC,Hc Pr 77001 Fluoroguide For Vein Device,1,158, 150.10 ,199.32, 150.10 , 202.34 , 202.34 ,Current Medicare Rates,153.26,151.68,150.1,150.1,Included in ER Case rate,150.1,150.1, 202.34 ,142.2
97210041,EAP,CPT® 93888,,0972 - PROFESSIONAL FEES - RADIOLOGY - DIAGNOSTIC,Hc Pr 93888 Transcranial Doppler Ltd,1,372, 353.40 ,314.82, 353.40 , 319.59 , 319.59 ,Current Medicare Rates,360.84,357.12,353.4,353.4,Included in ER Case rate,353.4,314.82, 360.84 ,334.8
97514150,EAP,10081,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 10081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED CDM,1,655, 622.25 ,336.6, 622.25 , 341.70 , 341.70 ,Current Medicare Rates,635.35,628.8,622.25,622.25,Included in ER Case rate,622.25,336.6, 635.35 ,589.5
97510050,EAP,11302,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11302 SHAVE SKIN LESION 1.1 TO 2.0 CM TRNK ARM LEG,1,316, 300.20 ,116.82, 300.20 , 118.59 , 118.59 ,Current Medicare Rates,306.52,303.36,300.2,300.2,Included in ER Case rate,300.2,116.82, 306.52 ,284.4
97510050,EAP,11302,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11302 SHAVE SKIN LESION 1.1 TO 2.0 CM TRNK ARM LEG,1,316, 300.20 ,116.82, 300.20 , 118.59 , 118.59 ,Current Medicare Rates,306.52,303.36,300.2,300.2,Included in ER Case rate,300.2,116.82, 306.52 ,284.4
97510050,EAP,11302,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11302 SHAVE SKIN LESION 1.1 TO 2.0 CM TRNK ARM LEG,1,316, 300.20 ,116.82, 300.20 , 118.59 , 118.59 ,Current Medicare Rates,306.52,303.36,300.2,300.2,Included in ER Case rate,300.2,116.82, 306.52 ,284.4
97510050,EAP,11302,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11302 SHAVE SKIN LESION 1.1 TO 2.0 CM TRNK ARM LEG,1,316, 300.20 ,116.82, 300.20 , 118.59 , 118.59 ,Current Medicare Rates,306.52,303.36,300.2,300.2,Included in ER Case rate,300.2,116.82, 306.52 ,284.4
97510063,EAP,11311,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11311 SHAVE SKIN LESION 0.6 TO 1.0 CM FACE ERS EYLD NSE LPS MUC,1,330, 313.50 ,122.76, 313.50 , 124.62 , 124.62 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,122.76, 320.10 ,297
97510063,EAP,11311,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11311 SHAVE SKIN LESION 0.6 TO 1.0 CM FACE ERS EYLD NSE LPS MUC,1,330, 313.50 ,122.76, 313.50 , 124.62 , 124.62 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,122.76, 320.10 ,297
97510063,EAP,11311,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11311 SHAVE SKIN LESION 0.6 TO 1.0 CM FACE ERS EYLD NSE LPS MUC,1,330, 313.50 ,122.76, 313.50 , 124.62 , 124.62 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,122.76, 320.10 ,297
97514005,EAP,11424,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11424 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM  CDM,1,507, 481.65 ,351.12, 481.65 , 356.44 , 356.44 ,Current Medicare Rates,491.79,486.72,481.65,481.65,Included in ER Case rate,481.65,351.12, 491.79 ,456.3
97514005,EAP,11424,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11424 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM  CDM,1,507, 481.65 ,351.12, 481.65 , 356.44 , 356.44 ,Current Medicare Rates,491.79,486.72,481.65,481.65,Included in ER Case rate,481.65,351.12, 491.79 ,456.3
97514005,EAP,11424,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11424 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM  CDM,1,507, 481.65 ,351.12, 481.65 , 356.44 , 356.44 ,Current Medicare Rates,491.79,486.72,481.65,481.65,Included in ER Case rate,481.65,351.12, 491.79 ,456.3
97510342,EAP,17272,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 17272 DESTRUCTION OF SKIN LESIONS OTHER M 1.1-2,1,422, 400.90 ,236.94, 400.90 , 240.53 , 240.53 ,Current Medicare Rates,409.34,405.12,400.9,400.9,Included in ER Case rate,400.9,236.94, 409.34 ,379.8
97510342,EAP,17272,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 17272 DESTRUCTION OF SKIN LESIONS OTHER M 1.1-2,1,422, 400.90 ,236.94, 400.90 , 240.53 , 240.53 ,Current Medicare Rates,409.34,405.12,400.9,400.9,Included in ER Case rate,400.9,236.94, 409.34 ,379.8
97510345,EAP,17276,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 17276 DESTRUCTION OF SKIN LESIONS OTHER M >4,1,663, 629.85 ,395.34, 629.85 , 401.33 , 401.33 ,Current Medicare Rates,643.11,636.48,629.85,629.85,Included in ER Case rate,629.85,395.34, 643.11 ,596.7
97510345,EAP,17276,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 17276 DESTRUCTION OF SKIN LESIONS OTHER M >4,1,663, 629.85 ,395.34, 629.85 , 401.33 , 401.33 ,Current Medicare Rates,643.11,636.48,629.85,629.85,Included in ER Case rate,629.85,395.34, 643.11 ,596.7
97510345,EAP,17276,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 17276 DESTRUCTION OF SKIN LESIONS OTHER M >4,1,663, 629.85 ,395.34, 629.85 , 401.33 , 401.33 ,Current Medicare Rates,643.11,636.48,629.85,629.85,Included in ER Case rate,629.85,395.34, 643.11 ,596.7
97510374,EAP,19318,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 19318 REDUCTION OF LARGE BREAST,1,2398," 2,278.10 ",2158.2," 2,278.10 "," 2,190.90 "," 2,190.90 ",Current Medicare Rates,2326.06,2302.08,2278.1,2278.1,Included in ER Case rate,2278.1,2158.2," 2,326.06 ",2158.2
97510383,EAP,20612,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 20612 ASPIRATE/INJ GANGLION CYST,1,152, 144.40 ,80.52, 144.40 , 81.74 , 81.74 ,Current Medicare Rates,147.44,145.92,144.4,144.4,Included in ER Case rate,144.4,80.52, 147.44 ,136.8
97510391,EAP,21011,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 21011 EXC FACE LES SC < 2 CM,1,843, 800.85 ,515.46, 800.85 , 523.27 , 523.27 ,Current Medicare Rates,817.71,809.28,800.85,800.85,Included in ER Case rate,800.85,515.46, 817.71 ,758.7
97511323,EAP,25606,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 25606 PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP,1,1445," 1,372.75 ",1335.18," 1,372.75 "," 1,355.41 "," 1,355.41 ",Current Medicare Rates,1401.65,1387.2,1372.75,1372.75,Included in ER Case rate,1372.75,1335.18," 1,401.65 ",1300.5
97500047,EAP,26055,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 26055 INCISE FINGER TENDON SHEATH [26055] CDM,1,1125," 1,068.75 ",584.76," 1,068.75 ", 593.62 , 593.62 ,Current Medicare Rates,1091.25,1080,1068.75,1068.75,Included in ER Case rate,1068.75,584.76," 1,091.25 ",1012.5
97511324,EAP,26160,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 26160 EXC LESION TDN SHTH/JT CAPSL HAND/FNGR,1,1235," 1,173.25 ",634.26," 1,173.25 ", 643.87 , 643.87 ,Current Medicare Rates,1197.95,1185.6,1173.25,1173.25,Included in ER Case rate,1173.25,634.26," 1,197.95 ",1111.5
97511327,EAP,27236,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 27236 OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT,1,2486," 2,361.70 ",2356.2," 2,361.70 "," 2,391.90 "," 2,391.90 ",Current Medicare Rates,2411.42,2386.56,2361.7,2361.7,Included in ER Case rate,2361.7,2356.2," 2,411.42 ",2237.4
97510942,EAP,27327,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 27327 EXC THIGH/KNEE LES SC < 3 CM,1,1004, 953.80 ,626.34, 953.80 , 635.83 , 635.83 ,Current Medicare Rates,973.88,963.84,953.8,953.8,Included in ER Case rate,953.8,626.34, 973.88 ,903.6
97510953,EAP,27618,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 27618 EXC LEG/ANKLE TUM < 3 CM,1,1076," 1,022.20 ",607.86," 1,022.20 ", 617.07 , 617.07 ,Current Medicare Rates,1043.72,1032.96,1022.2,1022.2,Included in ER Case rate,1022.2,607.86," 1,043.72 ",968.4
97511334,EAP,27792,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 27792 OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS,1,1411," 1,340.45 ",1283.7," 1,340.45 "," 1,303.15 "," 1,303.15 ",Current Medicare Rates,1368.67,1354.56,1340.45,1340.45,Included in ER Case rate,1340.45,1283.7," 1,368.67 ",1269.9
97510964,EAP,27822,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 27822 OPEN TX OF ANKLE FRACTURE W/O FIXATION OF POSTERIOR LIP,1,1799," 1,709.05 ",1738.44," 1,709.05 "," 1,764.78 "," 1,764.78 ",Current Medicare Rates,1745.03,1727.04,1709.05,1709.05,Included in ER Case rate,1709.05,1709.05," 1,764.78 ",1619.1
97510981,EAP,29876,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 29876 KNEE ARTHRO SYNOVECTOMY >=2,1,1357," 1,289.15 ",1296.9," 1,289.15 "," 1,316.55 "," 1,316.55 ",Current Medicare Rates,1316.29,1302.72,1289.15,1289.15,Included in ER Case rate,1289.15,1289.15," 1,316.55 ",1221.3
97514056,EAP,36556,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>  CDM,1,483, 458.85 ,163.68, 458.85 , 166.16 , 166.16 ,Current Medicare Rates,468.51,463.68,458.85,458.85,Included in ER Case rate,458.85,163.68, 468.51 ,434.7
97510989,EAP,36590,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 36590 REMOVAL TUNNELED CV CATH W/PORT OR PUMP,1,484, 459.80 ,370.92, 459.80 , 376.54 , 376.54 ,Current Medicare Rates,469.48,464.64,459.8,459.8,Included in ER Case rate,459.8,370.92, 469.48 ,435.6
97510297,EAP,43241,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 43241 EGD TUBE/CATH INSERTION,1,294, 279.30 ,274.56, 279.30 , 278.72 , 278.72 ,Current Medicare Rates,285.18,282.24,279.3,279.3,Included in ER Case rate,279.3,274.56, 285.18 ,264.6
97512949,EAP,44386,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 44386 ENDOSCOPY BOWEL POUCH/BIOP,1,678, 644.10 ,173.58, 644.10 , 176.21 , 176.21 ,Current Medicare Rates,657.66,650.88,644.1,644.1,Included in ER Case rate,644.1,173.58, 657.66 ,610.2
97510734,EAP,44800,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 44800 EXCISION OF BOWEL POUCH,1,1692," 1,607.40 ",1530.54," 1,607.40 "," 1,553.73 "," 1,553.73 ",Current Medicare Rates,1641.24,1624.32,1607.4,1607.4,Included in ER Case rate,1607.4,1530.54," 1,641.24 ",1522.8
97510734,EAP,44800,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 44800 EXCISION OF BOWEL POUCH,1,1692," 1,607.40 ",1530.54," 1,607.40 "," 1,553.73 "," 1,553.73 ",Current Medicare Rates,1641.24,1624.32,1607.4,1607.4,Included in ER Case rate,1607.4,1530.54," 1,641.24 ",1522.8
97510764,EAP,45335,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 45335 SIGMOIDOSCOPY W/SUBMUC INJ,1,602, 571.90 ,130.02, 571.90 , 131.99 , 131.99 ,Current Medicare Rates,583.94,577.92,571.9,571.9,Included in ER Case rate,571.9,130.02, 583.94 ,541.8
97511487,EAP,51040,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 51040 CYSTOSTOMY CYSTOTOMY W/DRAINAGE CDM,1,630, 598.50 ,570.24, 598.50 , 578.88 , 578.88 ,Current Medicare Rates,611.1,604.8,598.5,598.5,Included in ER Case rate,598.5,570.24, 611.10 ,567
97513623,EAP,64646,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64646 CHEMODENERV TRUNK MUSC 1-5,1,667, 633.65 ,227.7, 633.65 , 231.15 , 231.15 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,227.7, 646.99 ,600.3
97513623,EAP,64646,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64646 CHEMODENERV TRUNK MUSC 1-5,1,667, 633.65 ,227.7, 633.65 , 231.15 , 231.15 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,227.7, 646.99 ,600.3
97513623,EAP,64646,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64646 CHEMODENERV TRUNK MUSC 1-5,1,667, 633.65 ,227.7, 633.65 , 231.15 , 231.15 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,227.7, 646.99 ,600.3
97513623,EAP,64646,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64646 CHEMODENERV TRUNK MUSC 1-5,1,667, 633.65 ,227.7, 633.65 , 231.15 , 231.15 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,227.7, 646.99 ,600.3
97513623,EAP,64646,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64646 CHEMODENERV TRUNK MUSC 1-5,1,667, 633.65 ,227.7, 633.65 , 231.15 , 231.15 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,227.7, 646.99 ,600.3
97513624,EAP,64647,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64647 CHEMODENERV TRUNK MUSC 6/>,1,667, 633.65 ,262.68, 633.65 , 266.66 , 266.66 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,262.68, 646.99 ,600.3
97513624,EAP,64647,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64647 CHEMODENERV TRUNK MUSC 6/>,1,667, 633.65 ,262.68, 633.65 , 266.66 , 266.66 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,262.68, 646.99 ,600.3
97513624,EAP,64647,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64647 CHEMODENERV TRUNK MUSC 6/>,1,667, 633.65 ,262.68, 633.65 , 266.66 , 266.66 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,262.68, 646.99 ,600.3
97513624,EAP,64647,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64647 CHEMODENERV TRUNK MUSC 6/>,1,667, 633.65 ,262.68, 633.65 , 266.66 , 266.66 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,262.68, 646.99 ,600.3
97513624,EAP,64647,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64647 CHEMODENERV TRUNK MUSC 6/>,1,667, 633.65 ,262.68, 633.65 , 266.66 , 266.66 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,262.68, 646.99 ,600.3
97513472,EAP,64650,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64650 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,79.86, 260.30 , 81.07 , 81.07 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,79.86, 265.78 ,246.6
97513472,EAP,64650,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64650 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,79.86, 260.30 , 81.07 , 81.07 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,79.86, 265.78 ,246.6
97513472,EAP,64650,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64650 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,79.86, 260.30 , 81.07 , 81.07 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,79.86, 265.78 ,246.6
97513472,EAP,64650,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64650 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,79.86, 260.30 , 81.07 , 81.07 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,79.86, 265.78 ,246.6
97513472,EAP,64650,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64650 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,79.86, 260.30 , 81.07 , 81.07 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,79.86, 265.78 ,246.6
97513473,EAP,64653,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64653 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,101.64, 260.30 , 103.18 , 103.18 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,101.64, 265.78 ,246.6
97513473,EAP,64653,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64653 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,101.64, 260.30 , 103.18 , 103.18 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,101.64, 265.78 ,246.6
97513473,EAP,64653,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64653 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,101.64, 260.30 , 103.18 , 103.18 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,101.64, 265.78 ,246.6
97513473,EAP,64653,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64653 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,101.64, 260.30 , 103.18 , 103.18 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,101.64, 265.78 ,246.6
97513473,EAP,64653,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 64653 CHEMODENERV ECCRINE GLANDS,1,274, 260.30 ,101.64, 260.30 , 103.18 , 103.18 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,101.64, 265.78 ,246.6
97510670,EAP,67840,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 67840 REMOVE EYELID LESN (NOT CHALAZION),1,599, 569.05 ,306.24, 569.05 , 310.88 , 310.88 ,Current Medicare Rates,581.03,575.04,569.05,569.05,Included in ER Case rate,569.05,306.24, 581.03 ,539.1
97511187,EAP,CPT® 69205,,0975 - PROFESSIONAL FEES - OPERATING ROOM,CLEAR OUTER EAR CANAL W/ GENERAL ANESTHESIA,1,710, 674.50 ,190.08, 674.50 , 192.96 , 192.96 ,Current Medicare Rates,688.7,681.6,674.5,674.5,Included in ER Case rate,674.5,190.08, 688.70 ,639
97510346,EAP,CPT® 17280,,0975 - PROFESSIONAL FEES - OPERATING ROOM,DESTRUCTION OF SKIN LESIONS FC EAR EYLDS NS LIP MUC 0.5 CM OR LESS,1,315, 299.25 ,168.96, 299.25 , 171.52 , 171.52 ,Current Medicare Rates,305.55,302.4,299.25,299.25,Included in ER Case rate,299.25,168.96, 305.55 ,283.5
97510068,EAP,CPT® 11402,,0975 - PROFESSIONAL FEES - OPERATING ROOM,EXC TR-EXT B9+MARG 1.1-2 CM,1,428, 406.60 ,227.7, 406.60 , 231.15 , 231.15 ,Current Medicare Rates,415.16,410.88,406.6,406.6,Included in ER Case rate,406.6,227.7, 415.16 ,385.2
97511272,EAP,CPT® 10005,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 10005 Fine Needle Aspiration Bx W/us Gdn 1st Lesion,1,284, 269.80 ,143.88, 269.80 , 146.06 , 146.06 ,Current Medicare Rates,275.48,272.64,269.8,269.8,Included in ER Case rate,269.8,143.88, 275.48 ,255.6
97511275,EAP,CPT® 10006,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 10006 Fine Needle Aspiration Bx W/us Gdn Ea Addl,1,135, 128.25 ,97.68, 128.25 , 99.16 , 99.16 ,Current Medicare Rates,130.95,129.6,128.25,128.25,Included in ER Case rate,128.25,97.68, 130.95 ,121.5
97510032,EAP,CPT® 11010,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11010 Debride Skin At Fx Site,1,1060," 1,007.00 ",543.18," 1,007.00 ", 551.41 , 551.41 ,Current Medicare Rates,1028.2,1017.6,1007,1007,Included in ER Case rate,1007,543.18," 1,028.20 ",954
97510036,EAP,CPT® 11012,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11012 Deb Skin Bone At Fx Site,1,2619," 2,488.05 ",815.1," 2,488.05 ", 827.45 , 827.45 ,Current Medicare Rates,2540.43,2514.24,2488.05,2488.05,Included in ER Case rate,2488.05,815.1," 2,540.43 ",2357.1
97511282,EAP,CPT® 11102,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11102 Tangential Biopsy Skin Single Lesion,1,233, 221.35 ,73.92, 221.35 , 75.04 , 75.04 ,Current Medicare Rates,226.01,223.68,221.35,221.35,Included in ER Case rate,221.35,73.92, 226.01 ,209.7
97510044,EAP,CPT® 11200,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11200 Removal Of Skin Tags,1,190, 180.50 ,150.48, 180.50 , 152.76 , 152.76 ,Current Medicare Rates,184.3,182.4,180.5,180.5,Included in ER Case rate,180.5,150.48, 184.30 ,171
97510046,EAP,CPT® 11300,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11300 Shave Skin Lesion 0.5 Cm Or Less Trnk Arm Leg,1,251, 238.45 ,66.66, 238.45 , 67.67 , 67.67 ,Current Medicare Rates,243.47,240.96,238.45,238.45,Included in ER Case rate,238.45,66.66, 243.47 ,225.9
97514000,EAP,CPT® 11306,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 11306 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM  CDM  CDM,1,278, 264.10 ,96.36, 264.10 , 97.82 , 97.82 ,Current Medicare Rates,269.66,266.88,264.1,264.1,Included in ER Case rate,264.1,96.36, 269.66 ,250.2
97510060,EAP,CPT® 11310,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11310 Shave Skin Lesion 0.5 Cm Or Less Face Ers Eyld Nse Lps Muc,1,268.8, 255.36 ,89.76, 255.36 , 91.12 , 91.12 ,Current Medicare Rates,260.74,258.05,255.36,255.36,Included in ER Case rate,255.36,89.76, 260.74 ,241.92
97510066,EAP,CPT® 11400,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11400 Exc Tr-ext B9+marg 0.5 < Cm,1,337, 320.15 ,165.66, 320.15 , 168.17 , 168.17 ,Current Medicare Rates,326.89,323.52,320.15,320.15,Included in ER Case rate,320.15,165.66, 326.89 ,303.3
97510070,EAP,CPT® 11403,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 11403 Exc Skin Benig 2.1-3cm Trunk, Arm, Leg",1,495, 470.25 ,293.7, 470.25 , 298.15 , 298.15 ,Current Medicare Rates,480.15,475.2,470.25,470.25,Included in ER Case rate,470.25,293.7, 480.15 ,445.5
97510074,EAP,CPT® 11420,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11420 Exc H-f-nk-sp B9+marg 0.5 <,1,317, 301.15 ,161.7, 301.15 , 164.15 , 164.15 ,Current Medicare Rates,307.49,304.32,301.15,301.15,Included in ER Case rate,301.15,161.7, 307.49 ,285.3
97510075,EAP,CPT® 11422,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11422 Exc H-f-nk-sp B9+marg 1.1-2,1,454, 431.30 ,267.3, 431.30 , 271.35 , 271.35 ,Current Medicare Rates,440.38,435.84,431.3,431.3,Included in ER Case rate,431.3,267.3, 440.38 ,408.6
97510076,EAP,CPT® 11423,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11423 Exc H-f-nk-sp B9+marg 2.1-3,1,439, 417.05 ,307.56, 417.05 , 312.22 , 312.22 ,Current Medicare Rates,425.83,421.44,417.05,417.05,Included in ER Case rate,417.05,307.56, 425.83 ,395.1
97510078,EAP,CPT® 11440,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11440 Exc Face-mm B9+marg 0.5 < Cm,1,333, 316.35 ,209.22, 316.35 , 212.39 , 212.39 ,Current Medicare Rates,323.01,319.68,316.35,316.35,Included in ER Case rate,316.35,209.22, 323.01 ,299.7
97510079,EAP,CPT® 11442,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11442 Exc Face-mm B9+marg 1.1-2 Cm,1,426, 404.70 ,289.08, 404.70 , 293.46 , 293.46 ,Current Medicare Rates,413.22,408.96,404.7,404.7,Included in ER Case rate,404.7,289.08, 413.22 ,383.4
97510080,EAP,CPT® 11443,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11443 Exc Face-mm B9+marg 2.1-3 Cm,1,534, 507.30 ,351.78, 507.30 , 357.11 , 357.11 ,Current Medicare Rates,517.98,512.64,507.3,507.3,Included in ER Case rate,507.3,351.78, 517.98 ,480.6
97510458,EAP,CPT® 11606,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11606 Exc Tr-ext Mlg+marg > 4 Cm,1,1019, 968.05 ,619.74, 968.05 , 629.13 , 629.13 ,Current Medicare Rates,988.43,978.24,968.05,968.05,Included in ER Case rate,968.05,619.74, 988.43 ,917.1
97510082,EAP,CPT® 11621,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11621 Exc H-f-nk-sp Mlg+marg 0.6-1,1,595, 565.25 ,293.04, 565.25 , 297.48 , 297.48 ,Current Medicare Rates,577.15,571.2,565.25,565.25,Included in ER Case rate,565.25,293.04, 577.15 ,535.5
97510083,EAP,CPT® 11622,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11622 Exc H-f-nk-sp Mlg+marg 1.1-2,1,660, 627.00 ,331.32, 627.00 , 336.34 , 336.34 ,Current Medicare Rates,640.2,633.6,627,627,Included in ER Case rate,627,331.32, 640.20 ,594
97510084,EAP,CPT® 11623,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11623 Exc H-f-nk-sp Mlg+marg 2.1-3,1,776, 737.20 ,410.52, 737.20 , 416.74 , 416.74 ,Current Medicare Rates,752.72,744.96,737.2,737.2,Included in ER Case rate,737.2,410.52, 752.72 ,698.4
97510085,EAP,CPT® 11624,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11624 Exc H-f-nk-sp Mlg+marg 3.1-4,1,765, 726.75 ,465.96, 726.75 , 473.02 , 473.02 ,Current Medicare Rates,742.05,734.4,726.75,726.75,Included in ER Case rate,726.75,465.96, 742.05 ,688.5
97510087,EAP,CPT® 11640,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11640 Exc Face-mm Malig+marg 0.5 <,1,520, 494.00 ,248.16, 494.00 , 251.92 , 251.92 ,Current Medicare Rates,504.4,499.2,494,494,Included in ER Case rate,494,248.16, 504.40 ,468
97510088,EAP,CPT® 11641,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11641 Exc Face-mm Malig+marg 0.6-1,1,613, 582.35 ,304.92, 582.35 , 309.54 , 309.54 ,Current Medicare Rates,594.61,588.48,582.35,582.35,Included in ER Case rate,582.35,304.92, 594.61 ,551.7
97510089,EAP,CPT® 11642,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11642 Exc Face-mm Malig+marg 1.1-2,1,734, 697.30 ,355.74, 697.30 , 361.13 , 361.13 ,Current Medicare Rates,711.98,704.64,697.3,697.3,Included in ER Case rate,697.3,355.74, 711.98 ,660.6
97510090,EAP,CPT® 11643,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11643 Exc Face-mm Malig+marg 2.1-3,1,826, 784.70 ,444.84, 784.70 , 451.58 , 451.58 ,Current Medicare Rates,801.22,792.96,784.7,784.7,Included in ER Case rate,784.7,444.84, 801.22 ,743.4
97510093,EAP,CPT® 11770,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11770 Removal Of Pilonidal Lesion Simple,1,657, 624.15 ,366.3, 624.15 , 371.85 , 371.85 ,Current Medicare Rates,637.29,630.72,624.15,624.15,Included in ER Case rate,624.15,366.3, 637.29 ,591.3
97510462,EAP,CPT® 11771,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11771 Removal Of Pilonidal Lesion Exten,1,1372," 1,303.40 ",889.68," 1,303.40 ", 903.16 , 903.16 ,Current Medicare Rates,1330.84,1317.12,1303.4,1303.4,Included in ER Case rate,1303.4,889.68," 1,330.84 ",1234.8
97510097,EAP,CPT® 11981,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11981 Insert Drug Implant Device,1,302, 286.90 ,122.76, 286.90 , 124.62 , 124.62 ,Current Medicare Rates,292.94,289.92,286.9,286.9,Included in ER Case rate,286.9,122.76, 292.94 ,271.8
97510098,EAP,CPT® 11982,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11982 Remove Drug Implant Device,1,377, 358.15 ,145.2, 358.15 , 147.40 , 147.40 ,Current Medicare Rates,365.69,361.92,358.15,358.15,Included in ER Case rate,358.15,145.2, 365.69 ,339.3
97510099,EAP,CPT® 11983,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 11983 Remove/insert Drug Implant,1,523, 496.85 ,203.28, 496.85 , 206.36 , 206.36 ,Current Medicare Rates,507.31,502.08,496.85,496.85,Included in ER Case rate,496.85,203.28, 507.31 ,470.7
97510033,EAP,CPT® 15730,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 15730 Mdfc Flap W/prsrv Vasc Pedcl,1,3683," 3,498.85 ",1795.2," 3,498.85 "," 1,822.40 "," 1,822.40 ",Current Medicare Rates,3572.51,3535.68,3498.85,3498.85,Included in ER Case rate,3498.85,1795.2," 3,572.51 ",3314.7
97510035,EAP,CPT® 15733,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 15733 Musc Myoq/fscq Flp H&n Pedcl,1,2512," 2,386.40 ",2028.84," 2,386.40 "," 2,059.58 "," 2,059.58 ",Current Medicare Rates,2436.64,2411.52,2386.4,2386.4,Included in ER Case rate,2386.4,2028.84," 2,436.64 ",2260.8
97510330,EAP,CPT® 15839,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 15839 Excise Excessive Skin Tissue Other Area,1,2111," 2,005.45 ",1461.9," 2,005.45 "," 1,484.05 "," 1,484.05 ",Current Medicare Rates,2047.67,2026.56,2005.45,2005.45,Included in ER Case rate,2005.45,1461.9," 2,047.67 ",1899.9
97510334,EAP,CPT® 17000,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 17000 Destruct Premalg Lesion First Lesion,1,171, 162.45 ,107.58, 162.45 , 109.21 , 109.21 ,Current Medicare Rates,165.87,164.16,162.45,162.45,Included in ER Case rate,162.45,107.58, 165.87 ,153.9
97510335,EAP,CPT® 17003,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 17003 Destruct Premalg Les 2-14,1,16, 15.20 ,3.96, 15.20 , 4.02 , 4.02 ,Current Medicare Rates,15.52,15.36,15.2,15.2,Included in ER Case rate,15.2,3.96, 15.52 ,14.4
97510338,EAP,CPT® 17260,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 17260 Destruction Of Skin Lesions Tnk/arm/lg M<=0.5,1,224, 212.80 ,138.6, 212.80 , 140.70 , 140.70 ,Current Medicare Rates,217.28,215.04,212.8,212.8,Included in ER Case rate,212.8,138.6, 217.28 ,201.6
97510340,EAP,CPT® 17270,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 17270 Destruction Of Skin Lesions Other M <=0.5,1,610, 579.50 ,187.44, 579.50 , 190.28 , 190.28 ,Current Medicare Rates,591.7,585.6,579.5,579.5,Included in ER Case rate,579.5,187.44, 591.70 ,549
97510352,EAP,CPT® 19001,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 19001 Drain Breast Lesion Add-on,1,61, 57.95 ,40.26, 57.95 , 40.87 , 40.87 ,Current Medicare Rates,59.17,58.56,57.95,57.95,Included in ER Case rate,57.95,40.26, 59.17 ,54.9
97510356,EAP,CPT® 19101,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 19101 Biopsy Of Breast Open,1,806, 765.70 ,442.86, 765.70 , 449.57 , 449.57 ,Current Medicare Rates,781.82,773.76,765.7,765.7,Included in ER Case rate,765.7,442.86, 781.82 ,725.4
97510370,EAP,CPT® 19305,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 19305 Mast Radical,1,2584," 2,454.80 ",2277," 2,454.80 "," 2,311.50 "," 2,311.50 ",Current Medicare Rates,2506.48,2480.64,2454.8,2454.8,Included in ER Case rate,2454.8,2277," 2,506.48 ",2325.6
97510373,EAP,CPT® 19307,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 19307 Mast Mod Rad,1,2735," 2,598.25 ",2333.1," 2,598.25 "," 2,368.45 "," 2,368.45 ",Current Medicare Rates,2652.95,2625.6,2598.25,2598.25,Included in ER Case rate,2598.25,2333.1," 2,652.95 ",2461.5
97510378,EAP,CPT® 20205,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 20205 Deep Muscle Biopsy,1,3162," 3,003.90 ",304.26," 3,003.90 ", 308.87 , 308.87 ,Current Medicare Rates,3067.14,3035.52,3003.9,3003.9,Included in ER Case rate,3003.9,304.26," 3,067.14 ",2845.8
97511738,EAP,CPT® 20822,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 20822 Replantation Digit Complete,1,4377," 4,158.15 ",3490.74," 4,158.15 "," 3,543.63 "," 3,543.63 ",Current Medicare Rates,4245.69,4201.92,4158.15,4158.15,Included in ER Case rate,4158.15,3490.74," 4,245.69 ",3939.3
97510040,EAP,CPT® 20939,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 20939 Bone Marrow Aspir Bone Grfg,1,162, 153.90 ,137.94, 153.90 , 140.03 , 140.03 ,Current Medicare Rates,157.14,155.52,153.9,153.9,Included in ER Case rate,153.9,137.94, 157.14 ,145.8
97510392,EAP,CPT® 21012,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 21012 Exc Face Les Sbq 2+ Cm,1,810, 769.50 ,673.2, 769.50 , 683.40 , 683.40 ,Current Medicare Rates,785.7,777.6,769.5,769.5,Included in ER Case rate,769.5,673.2, 785.70 ,729
97511883,EAP,CPT® 21406,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 21406 Opn Tx Orbit Fx W/o Implant,1,2166," 2,057.70 ",1156.32," 2,057.70 "," 1,173.84 "," 1,173.84 ",Current Medicare Rates,2101.02,2079.36,2057.7,2057.7,Included in ER Case rate,2057.7,1156.32," 2,101.02 ",1949.4
97514033,EAP,CPT® 21501,,0975 - PROFESSIONAL FEES - OPERATING ROOM,HC PR 21501 I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX  CDM  CDM,1,1066," 1,012.70 ",665.94," 1,012.70 ", 676.03 , 676.03 ,Current Medicare Rates,1034.02,1023.36,1012.7,1012.7,Included in ER Case rate,1012.7,665.94," 1,034.02 ",959.4
97510403,EAP,CPT® 21552,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 21552 Exc Neck Les Sc 3+ Cm,1,1016, 965.20 ,887.04, 965.20 , 900.48 , 900.48 ,Current Medicare Rates,985.52,975.36,965.2,965.2,Included in ER Case rate,965.2,887.04, 985.52 ,914.4
97510406,EAP,CPT® 21556,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 21556 Exc Neck Tum Deep < 5 Cm,1,1277," 1,213.15 ",1054.02," 1,213.15 "," 1,069.99 "," 1,069.99 ",Current Medicare Rates,1238.69,1225.92,1213.15,1213.15,Included in ER Case rate,1213.15,1054.02," 1,238.69 ",1149.3
97510410,EAP,CPT® 21930,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 21930 Exc Back Les Sc < 3 Cm,1,571, 542.45 ,723.36, 542.45 , 734.32 , 734.32 ,Current Medicare Rates,553.87,548.16,542.45,542.45,Included in ER Case rate,542.45,542.45, 734.32 ,513.9
97510411,EAP,CPT® 21931,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 21931 Exc Back Les Sc 3+ Cm,1,1025, 973.75 ,931.26, 973.75 , 945.37 , 945.37 ,Current Medicare Rates,994.25,984,973.75,973.75,Included in ER Case rate,973.75,931.26, 994.25 ,922.5
97513630,EAP,CPT® 24300,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 24300 Manipulate Elbow W/anesth,1,1415," 1,344.25 ",876.48," 1,344.25 ", 889.76 , 889.76 ,Current Medicare Rates,1372.55,1358.4,1344.25,1344.25,Included in ER Case rate,1344.25,876.48," 1,372.55 ",1273.5
97512065,EAP,CPT® 25259,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 25259 Manipulate Wrist W/anesthes,1,1598," 1,518.10 ",868.56," 1,518.10 ", 881.72 , 881.72 ,Current Medicare Rates,1550.06,1534.08,1518.1,1518.1,Included in ER Case rate,1518.1,868.56," 1,550.06 ",1438.2
98110730,EAP,CPT® 25500,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 25500 Treat Fractue Of Radius W/o Manipulation,1,1057," 1,004.15 ",524.04," 1,004.15 ", 531.98 , 531.98 ,Current Medicare Rates,1025.29,1014.72,1004.15,1004.15,Included in ER Case rate,1004.15,524.04," 1,025.29 ",951.3
97511308,EAP,CPT® 26785,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 26785 Treat Finger Dislocation,1,1415," 1,344.25 ",1097.58," 1,344.25 "," 1,114.21 "," 1,114.21 ",Current Medicare Rates,1372.55,1358.4,1344.25,1344.25,Included in ER Case rate,1344.25,1097.58," 1,372.55 ",1273.5
97510930,EAP,CPT® 26990,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 26990 Drainage Of Pelvis Lesion,1,1500," 1,425.00 ",1356.96," 1,425.00 "," 1,377.52 "," 1,377.52 ",Current Medicare Rates,1455,1440,1425,1425,Included in ER Case rate,1425,1356.96," 1,455.00 ",1350
97511534,EAP,CPT® 27043,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 27043 Exc Tumor Hip Sq >3cm,1,1077," 1,023.15 ",931.26," 1,023.15 ", 945.37 , 945.37 ,Current Medicare Rates,1044.69,1033.92,1023.15,1023.15,Included in ER Case rate,1023.15,931.26," 1,044.69 ",969.3
97510931,EAP,CPT® 27047,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 27047 Exc Hip/pelvis Les Sc < 3 Cm,1,1130," 1,073.50 ",716.1," 1,073.50 ", 726.95 , 726.95 ,Current Medicare Rates,1096.1,1084.8,1073.5,1073.5,Included in ER Case rate,1073.5,716.1," 1,096.10 ",1017
97510941,EAP,CPT® 27324,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 27324 Biopsy Thigh Soft Tissues Deep,1,995, 945.25 ,819.06, 945.25 , 831.47 , 831.47 ,Current Medicare Rates,965.15,955.2,945.25,945.25,Included in ER Case rate,945.25,819.06, 965.15 ,895.5
97510673,EAP,CPT® 27530,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 27530 Cltx Tibial Fx Proximal W/o Manipulation,1,1529," 1,452.55 ",587.4," 1,452.55 ", 596.30 , 596.30 ,Current Medicare Rates,1483.13,1467.84,1452.55,1452.55,Included in ER Case rate,1452.55,587.4," 1,483.13 ",1376.1
97510966,EAP,CPT® 27880,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 27880 Amputation Of Lower Leg,1,2232," 2,120.40 ",1765.5," 2,120.40 "," 1,792.25 "," 1,792.25 ",Current Medicare Rates,2165.04,2142.72,2120.4,2120.4,Included in ER Case rate,2120.4,1765.5," 2,165.04 ",2008.8
97510042,EAP,CPT® 31241,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 31241 Nasal/sinus Ndsc W/artery Ligation,1,1068," 1,014.60 ",871.86," 1,014.60 ", 885.07 , 885.07 ,Current Medicare Rates,1035.96,1025.28,1014.6,1014.6,Included in ER Case rate,1014.6,871.86," 1,035.96 ",961.2
97510043,EAP,CPT® 31253,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 31253 Nasal/sinus Ndsc Total,1,1197," 1,137.15 ",981.42," 1,137.15 ", 996.29 , 996.29 ,Current Medicare Rates,1161.09,1149.12,1137.15,1137.15,Included in ER Case rate,1137.15,981.42," 1,161.09 ",1077.3
97510047,EAP,CPT® 31257,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 31257 Nasal/sinus Ndsc Tot W/sphendt,1,1066," 1,012.70 ",874.5," 1,012.70 ", 887.75 , 887.75 ,Current Medicare Rates,1034.02,1023.36,1012.7,1012.7,Included in ER Case rate,1012.7,874.5," 1,034.02 ",959.4
97510049,EAP,CPT® 31259,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 31259 Nasal/sinus Ndsc Sphn Tiss Rmvl,1,1130," 1,073.50 ",925.32," 1,073.50 ", 939.34 , 939.34 ,Current Medicare Rates,1096.1,1084.8,1073.5,1073.5,Included in ER Case rate,1073.5,925.32," 1,096.10 ",1017
97510051,EAP,CPT® 31298,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 31298 Nasal/sinus Ndsc W/sins Dilat,1,9146," 8,688.70 ",502.92," 8,688.70 ", 510.54 , 510.54 ,Current Medicare Rates,8871.62,8780.16,8688.7,8688.7,Included in ER Case rate,8688.7,502.92," 8,871.62 ",8231.4
97511404,EAP,CPT® 32554,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 32554 Thorancentesis Needle/cath Pleura W/o Imaging,1,475, 451.25 ,171.6, 451.25 , 174.20 , 174.20 ,Current Medicare Rates,460.75,456,451.25,451.25,Included in ER Case rate,451.25,171.6, 460.75 ,427.5
97510052,EAP,CPT® 32994,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 32994 Ablate Pulm Tumor Perq Crybl,1,14587," 13,857.65 ",844.8," 13,857.65 ", 857.60 , 857.60 ,Current Medicare Rates,14149.39,14003.52,13857.65,13857.65,Included in ER Case rate,13857.65,844.8," 14,149.39 ",13128.3
97511336,EAP,CPT® 33286,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 33286 Removal Subcutaneous Cardiac Rhythm Monitor,1,317, 301.15 ,168.3, 301.15 , 170.85 , 170.85 ,Current Medicare Rates,307.49,304.32,301.15,301.15,Included in ER Case rate,301.15,168.3, 307.49 ,285.3
97510054,EAP,CPT® 33927,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 33927 Impltj Tot Rplcmt Hrt Sys,1,6148," 5,840.60 ",4915.02," 5,840.60 "," 4,989.49 "," 4,989.49 ",Current Medicare Rates,5963.56,5902.08,5840.6,5840.6,Included in ER Case rate,5840.6,4915.02," 5,963.56 ",5533.2
97510203,EAP,CPT® 35840,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 35840 Explore Abdominal Vessels,1,2768," 2,629.60 ",2374.02," 2,629.60 "," 2,409.99 "," 2,409.99 ",Current Medicare Rates,2684.96,2657.28,2629.6,2629.6,Included in ER Case rate,2629.6,2374.02," 2,684.96 ",2491.2
97512703,EAP,CPT® 36011,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 36011 Place Catheter In Vein,1,1906," 1,810.70 ",300.96," 1,810.70 ", 305.52 , 305.52 ,Current Medicare Rates,1848.82,1829.76,1810.7,1810.7,Included in ER Case rate,1810.7,300.96," 1,848.82 ",1715.4
97510986,EAP,CPT® 36561,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 36561 Insert Tunneled Cv Cath W/port > 5,1,3309," 3,143.55 ",647.46," 3,143.55 ", 657.27 , 657.27 ,Current Medicare Rates,3209.73,3176.64,3143.55,3143.55,Included in ER Case rate,3143.55,647.46," 3,209.73 ",2978.1
97510220,EAP,CPT® 38500,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 38500 Biopsy/removal Lymph Nodes,1,909, 863.55 ,504.9, 863.55 , 512.55 , 512.55 ,Current Medicare Rates,881.73,872.64,863.55,863.55,Included in ER Case rate,863.55,504.9, 881.73 ,818.1
97510222,EAP,CPT® 38510,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 38510 Biopsy/removal Lymph Nodes Open, Deep Cervical Node(s)",1,1242," 1,179.90 ",827.64," 1,179.90 ", 840.18 , 840.18 ,Current Medicare Rates,1204.74,1192.32,1179.9,1179.9,Included in ER Case rate,1179.9,827.64," 1,204.74 ",1117.8
97510224,EAP,CPT® 38525,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 38525 Biopsy/removal Lymph Nodes, Deep Auxillary",1,1150," 1,092.50 ",872.52," 1,092.50 ", 885.74 , 885.74 ,Current Medicare Rates,1115.5,1104,1092.5,1092.5,Included in ER Case rate,1092.5,872.52," 1,115.50 ",1035
97510351,EAP,CPT® 38573,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 38573 Laps Pelvic Lymphadec,1,3952," 3,754.40 ",2308.68," 3,754.40 "," 2,343.66 "," 2,343.66 ",Current Medicare Rates,3833.44,3793.92,3754.4,3754.4,Included in ER Case rate,3754.4,2308.68," 3,833.44 ",3556.8
97512800,EAP,CPT® 38900,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 38900 Io Map Of Sent Lymph Node,1,332, 315.40 ,267.96, 315.40 , 272.02 , 272.02 ,Current Medicare Rates,322.04,318.72,315.4,315.4,Included in ER Case rate,315.4,267.96, 322.04 ,298.8
97510239,EAP,CPT® 41100,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 41100 Biopsy Of Tongue,1,510, 484.50 ,212.52, 484.50 , 215.74 , 215.74 ,Current Medicare Rates,494.7,489.6,484.5,484.5,Included in ER Case rate,484.5,212.52, 494.70 ,459
97510289,EAP,CPT® 43215,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43215 Esophagoscopy Flex Remove Fb,1,868, 824.60 ,273.9, 824.60 , 278.05 , 278.05 ,Current Medicare Rates,841.96,833.28,824.6,824.6,Included in ER Case rate,824.6,273.9, 841.96 ,781.2
97513603,EAP,CPT® 43233,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43233 Egd Balloon Dil Esoph30 Mm/>,1,288, 273.60 ,442.86, 273.60 , 449.57 , 449.57 ,Current Medicare Rates,279.36,276.48,273.6,273.6,Included in ER Case rate,273.6,273.6, 449.57 ,259.2
97510294,EAP,CPT® 43235,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43235 Egd Diagnostic Brush Wash,1,733, 696.35 ,237.6, 696.35 , 241.20 , 241.20 ,Current Medicare Rates,711.01,703.68,696.35,696.35,Included in ER Case rate,696.35,237.6, 711.01 ,659.7
97510296,EAP,CPT® 43239,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43239 Egd Biopsy Single/multiple,1,1050, 997.50 ,267.96, 997.50 , 272.02 , 272.02 ,Current Medicare Rates,1018.5,1008,997.5,997.5,Included in ER Case rate,997.5,267.96," 1,018.50 ",945
97511161,EAP,CPT® 43245,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43245 Egd Dilate Stricture,1,1518," 1,442.10 ",340.56," 1,442.10 ", 345.72 , 345.72 ,Current Medicare Rates,1472.46,1457.28,1442.1,1442.1,Included in ER Case rate,1442.1,340.56," 1,472.46 ",1366.2
97510501,EAP,CPT® 43247,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43247 Operative Upper Gi Endoscopy W/ Fb Removal,1,981, 931.95 ,342.54, 931.95 , 347.73 , 347.73 ,Current Medicare Rates,951.57,941.76,931.95,931.95,Included in ER Case rate,931.95,342.54, 951.57 ,882.9
97510503,EAP,CPT® 43249,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43249 Esoph Egd Dilation <30 Mm,1,2528," 2,401.60 ",297.66," 2,401.60 ", 302.17 , 302.17 ,Current Medicare Rates,2452.16,2426.88,2401.6,2401.6,Included in ER Case rate,2401.6,297.66," 2,452.16 ",2275.2
97510504,EAP,CPT® 43250,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43250 Egd Cautery Tumor Polyp,1,1079," 1,025.05 ",330," 1,025.05 ", 335.00 , 335.00 ,Current Medicare Rates,1046.63,1035.84,1025.05,1025.05,Included in ER Case rate,1025.05,330," 1,046.63 ",971.1
97510505,EAP,CPT® 43251,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43251 Egd Remove Lesion Snare,1,1127," 1,070.65 ",379.5," 1,070.65 ", 385.25 , 385.25 ,Current Medicare Rates,1093.19,1081.92,1070.65,1070.65,Included in ER Case rate,1070.65,379.5," 1,093.19 ",1014.3
97510359,EAP,CPT® 43286,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43286 Esphg Tot W/laps Moblj,1,7582," 7,202.90 ",6207.3," 7,202.90 "," 6,301.35 "," 6,301.35 ",Current Medicare Rates,7354.54,7278.72,7202.9,7202.9,Included in ER Case rate,7202.9,6207.3," 7,354.54 ",6823.8
97510364,EAP,CPT® 43287,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43287 Esphg Dstl 2/3 W/laps Moblj,1,8660," 8,227.00 ",6901.62," 8,227.00 "," 7,006.19 "," 7,006.19 ",Current Medicare Rates,8400.2,8313.6,8227,8227,Included in ER Case rate,8227,6901.62," 8,400.20 ",7794
97510366,EAP,CPT® 43288,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 43288 Esphg Thrsc Moblj,1,9036," 8,584.20 ",7288.38," 8,584.20 "," 7,398.81 "," 7,398.81 ",Current Medicare Rates,8764.92,8674.56,8584.2,8584.2,Included in ER Case rate,8584.2,7288.38," 8,764.92 ",8132.4
97510569,EAP,CPT® 44005,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44005 Freeing Of Bowel Adhesion,1,2764," 2,625.80 ",2147.64," 2,625.80 "," 2,180.18 "," 2,180.18 ",Current Medicare Rates,2681.08,2653.44,2625.8,2625.8,Included in ER Case rate,2625.8,2147.64," 2,681.08 ",2487.6
97510579,EAP,CPT® 44120,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 44120 Removal Of Small Intestine, Single Resection",1,2820," 2,679.00 ",2401.74," 2,679.00 "," 2,438.13 "," 2,438.13 ",Current Medicare Rates,2735.4,2707.2,2679,2679,Included in ER Case rate,2679,2401.74," 2,735.40 ",2538
97510580,EAP,CPT® 44121,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 44121 Removal Of Small Intestine, Each Add'l Resection",1,587, 557.65 ,470.58, 557.65 , 477.71 , 477.71 ,Current Medicare Rates,569.39,563.52,557.65,557.65,Included in ER Case rate,557.65,470.58, 569.39 ,528.3
97510584,EAP,CPT® 44139,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44139 Mobilization Of Colon,1,266, 252.70 ,234.96, 252.70 , 238.52 , 238.52 ,Current Medicare Rates,258.02,255.36,252.7,252.7,Included in ER Case rate,252.7,234.96, 258.02 ,239.4
97510585,EAP,CPT® 44140,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44140 Partial Removal Of Colon W/ Anastomosis,1,3090," 2,935.50 ",2637.36," 2,935.50 "," 2,677.32 "," 2,677.32 ",Current Medicare Rates,2997.3,2966.4,2935.5,2935.5,Included in ER Case rate,2935.5,2637.36," 2,997.30 ",2781
97510587,EAP,CPT® 44143,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 44143 Partial Removal Of Colon, Hartmann Procedure",1,4001," 3,800.95 ",3247.86," 3,800.95 "," 3,297.07 "," 3,297.07 ",Current Medicare Rates,3880.97,3840.96,3800.95,3800.95,Included in ER Case rate,3800.95,3247.86," 3,880.97 ",3600.9
97510588,EAP,CPT® 44144,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 44144 Partial Removal Of Colon, With Resection",1,3892," 3,697.40 ",3465," 3,697.40 "," 3,517.50 "," 3,517.50 ",Current Medicare Rates,3775.24,3736.32,3697.4,3697.4,Included in ER Case rate,3697.4,3465," 3,775.24 ",3502.8
97510599,EAP,CPT® 44180,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44180 Laparoscopy Enterolysis,1,4510," 4,284.50 ",1812.36," 4,284.50 "," 1,839.82 "," 1,839.82 ",Current Medicare Rates,4374.7,4329.6,4284.5,4284.5,Included in ER Case rate,4284.5,1812.36," 4,374.70 ",4059
97510705,EAP,CPT® 44213,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44213 Laparoscopy Mobilization Splenic Flexure Add-on,1,455, 432.25 ,362.34, 432.25 , 367.83 , 367.83 ,Current Medicare Rates,441.35,436.8,432.25,432.25,Included in ER Case rate,432.25,362.34, 441.35 ,409.5
97510709,EAP,CPT® 44320,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44320 Colostomy,1,2906," 2,760.70 ",2357.52," 2,760.70 "," 2,393.24 "," 2,393.24 ",Current Medicare Rates,2818.82,2789.76,2760.7,2760.7,Included in ER Case rate,2760.7,2357.52," 2,818.82 ",2615.4
97510717,EAP,CPT® 44388,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44388 Colonoscopy,1,698, 663.10 ,303.6, 663.10 , 308.20 , 308.20 ,Current Medicare Rates,677.06,670.08,663.1,663.1,Included in ER Case rate,663.1,303.6, 677.06 ,628.2
97510721,EAP,CPT® 44392,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44392 Colonoscopy & Polypectomy,1,990, 940.50 ,387.42, 940.50 , 393.29 , 393.29 ,Current Medicare Rates,960.3,950.4,940.5,940.5,Included in ER Case rate,940.5,387.42, 960.30 ,891
97510723,EAP,CPT® 44394,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44394 Colonoscopy W/snare,1,1111," 1,055.45 ",436.92," 1,055.45 ", 443.54 , 443.54 ,Current Medicare Rates,1077.67,1066.56,1055.45,1055.45,Included in ER Case rate,1055.45,436.92," 1,077.67 ",999.9
97510738,EAP,CPT® 44950,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44950 Appendectomy,1,1479," 1,405.05 ",1267.86," 1,405.05 "," 1,287.07 "," 1,287.07 ",Current Medicare Rates,1434.63,1419.84,1405.05,1405.05,Included in ER Case rate,1405.05,1267.86," 1,434.63 ",1331.1
97510741,EAP,CPT® 44970,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 44970 Laparoscopy Appendectomy,1,1446," 1,373.70 ",1191.96," 1,373.70 "," 1,210.02 "," 1,210.02 ",Current Medicare Rates,1402.62,1388.16,1373.7,1373.7,Included in ER Case rate,1373.7,1191.96," 1,402.62 ",1301.4
97510758,EAP,CPT® 45330,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45330 Diagnostic Sigmoidoscopy,1,678, 644.10 ,109.56, 644.10 , 111.22 , 111.22 ,Current Medicare Rates,657.66,650.88,644.1,644.1,Included in ER Case rate,644.1,109.56, 657.66 ,610.2
97510759,EAP,CPT® 45331,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45331 Sigmoidoscopy And Biopsy,1,575, 546.25 ,139.92, 546.25 , 142.04 , 142.04 ,Current Medicare Rates,557.75,552,546.25,546.25,Included in ER Case rate,546.25,139.92, 557.75 ,517.5
97510761,EAP,CPT® 45333,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45333 Sigmoidoscopy & Polypectomy,1,863, 819.85 ,182.16, 819.85 , 184.92 , 184.92 ,Current Medicare Rates,837.11,828.48,819.85,819.85,Included in ER Case rate,819.85,182.16, 837.11 ,776.7
97512963,EAP,CPT® 45337,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45337 Sigmoidoscopy & Decompress,1,264.6, 251.37 ,221.76, 251.37 , 225.12 , 225.12 ,Current Medicare Rates,256.66,254.02,251.37,251.37,Included in ER Case rate,251.37,221.76, 256.66 ,238.14
97510765,EAP,CPT® 45338,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45338 Sigmoidoscopy W/tumor Removal,1,1060," 1,007.00 ",232.98," 1,007.00 ", 236.51 , 236.51 ,Current Medicare Rates,1028.2,1017.6,1007,1007,Included in ER Case rate,1007,232.98," 1,028.20 ",954
97510766,EAP,CPT® 45378,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45378 Diagnostic Colonoscopy,1,1010, 959.50 ,357.72, 959.50 , 363.14 , 363.14 ,Current Medicare Rates,979.7,969.6,959.5,959.5,Included in ER Case rate,959.5,357.72, 979.70 ,909
97510768,EAP,CPT® 45380,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45380 Colonoscopy And Biopsy,1,1203," 1,142.85 ",388.74," 1,142.85 ", 394.63 , 394.63 ,Current Medicare Rates,1166.91,1154.88,1142.85,1142.85,Included in ER Case rate,1142.85,388.74," 1,166.91 ",1082.7
97510769,EAP,CPT® 45381,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45381 Colonoscopy Submucous Inj,1,1062," 1,008.90 ",388.08," 1,008.90 ", 393.96 , 393.96 ,Current Medicare Rates,1030.14,1019.52,1008.9,1008.9,Included in ER Case rate,1008.9,388.08," 1,030.14 ",955.8
97510772,EAP,CPT® 45384,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45384 Lesion Remove Colonoscopy,1,1205," 1,144.75 ",441.54," 1,144.75 ", 448.23 , 448.23 ,Current Medicare Rates,1168.85,1156.8,1144.75,1144.75,Included in ER Case rate,1144.75,441.54," 1,168.85 ",1084.5
97510773,EAP,CPT® 45385,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 45385 Lesion Removal Colonoscopy, Polyp Snare",1,1158," 1,100.10 ",491.7," 1,100.10 ", 499.15 , 499.15 ,Current Medicare Rates,1123.26,1111.68,1100.1,1100.1,Included in ER Case rate,1100.1,491.7," 1,123.26 ",1042.2
97512973,EAP,CPT® 45550,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45550 Repair Rectum/remove Sigmoid,1,3359," 3,191.05 ",2858.46," 3,191.05 "," 2,901.77 "," 2,901.77 ",Current Medicare Rates,3258.23,3224.64,3191.05,3191.05,Included in ER Case rate,3191.05,2858.46," 3,258.23 ",3023.1
97510782,EAP,CPT® 45990,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 45990 Surg Dx Exam Anorectal,1,256, 243.20 ,205.26, 243.20 , 208.37 , 208.37 ,Current Medicare Rates,248.32,245.76,243.2,243.2,Included in ER Case rate,243.2,205.26, 248.32 ,230.4
97510785,EAP,CPT® 46200,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 46200 Removal Of Anal Fissure,1,1078," 1,024.10 ",669.9," 1,024.10 ", 680.05 , 680.05 ,Current Medicare Rates,1045.66,1034.88,1024.1,1024.1,Included in ER Case rate,1024.1,669.9," 1,045.66 ",970.2
97510787,EAP,CPT® 46250,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 46250 Remove Ext Hem Groups 2+,1,1059," 1,006.05 ",632.28," 1,006.05 ", 641.86 , 641.86 ,Current Medicare Rates,1027.23,1016.64,1006.05,1006.05,Included in ER Case rate,1006.05,632.28," 1,027.23 ",953.1
97510788,EAP,CPT® 46255,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 46255 Remove Internal/external Hemorroid Single Group,1,1203," 1,142.85 ",704.22," 1,142.85 ", 714.89 , 714.89 ,Current Medicare Rates,1166.91,1154.88,1142.85,1142.85,Included in ER Case rate,1142.85,704.22," 1,166.91 ",1082.7
97510791,EAP,CPT® 46260,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 46260 Remove Internal/external Hemorroid Groups 2+,1,1140," 1,083.00 ",955.68," 1,083.00 ", 970.16 , 970.16 ,Current Medicare Rates,1105.8,1094.4,1083,1083,Included in ER Case rate,1083,955.68," 1,105.80 ",1026
97510803,EAP,CPT® 46922,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 46922 Excision Of Anal Lesion(s),1,734, 697.30 ,272.58, 697.30 , 276.71 , 276.71 ,Current Medicare Rates,711.98,704.64,697.3,697.3,Included in ER Case rate,697.3,272.58, 711.98 ,660.6
97513626,EAP,CPT® 46930,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 46930 Destruction Of Internal Hemorroids By Thermal Energy,1,488, 463.60 ,299.64, 463.60 , 304.18 , 304.18 ,Current Medicare Rates,473.36,468.48,463.6,463.6,Included in ER Case rate,463.6,299.64, 473.36 ,439.2
97512992,EAP,CPT® 46946,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 46946 Remove By Ligat Int Hem Grps,1,901, 855.95 ,754.38, 855.95 , 765.81 , 765.81 ,Current Medicare Rates,873.97,864.96,855.95,855.95,Included in ER Case rate,855.95,754.38, 873.97 ,810.9
97510102,EAP,CPT® 47000,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 47000 Needle Biopsy Of Liver,1,858, 815.10 ,170.94, 815.10 , 173.53 , 173.53 ,Current Medicare Rates,832.26,823.68,815.1,815.1,Included in ER Case rate,815.1,170.94, 832.26 ,772.2
97510818,EAP,CPT® 47562,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 47562 Laparoscopic Cholecystectomy,1,1578," 1,499.10 ",1304.16," 1,499.10 "," 1,323.92 "," 1,323.92 ",Current Medicare Rates,1530.66,1514.88,1499.1,1499.1,Included in ER Case rate,1499.1,1304.16," 1,530.66 ",1420.2
97510819,EAP,CPT® 47563,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 47563 Laparoscopy Cholecystectomy/graph,1,1978," 1,879.10 ",1421.64," 1,879.10 "," 1,443.18 "," 1,443.18 ",Current Medicare Rates,1918.66,1898.88,1879.1,1879.1,Included in ER Case rate,1879.1,1421.64," 1,918.66 ",1780.2
97510822,EAP,CPT® 47600,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 47600 Cholecystectomy,1,2580," 2,451.00 ",2110.68," 2,451.00 "," 2,142.66 "," 2,142.66 ",Current Medicare Rates,2502.6,2476.8,2451,2451,Included in ER Case rate,2451,2110.68," 2,502.60 ",2322
97510843,EAP,CPT® 49000,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 49000 Exploration Of Abdomen,1,1773," 1,684.35 ",1515.36," 1,684.35 "," 1,538.32 "," 1,538.32 ",Current Medicare Rates,1719.81,1702.08,1684.35,1684.35,Included in ER Case rate,1684.35,1515.36," 1,719.81 ",1595.7
97510859,EAP,CPT® 49322,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 49322 Laparoscopy Aspiration,1,887, 842.65 ,741.18, 842.65 , 752.41 , 752.41 ,Current Medicare Rates,860.39,851.52,842.65,842.65,Included in ER Case rate,842.65,741.18, 860.39 ,798.3
97510864,EAP,CPT® 49422,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 49422 Remove Tunneled Intraperitoneal Cath,1,921, 874.95 ,432.3, 874.95 , 438.85 , 438.85 ,Current Medicare Rates,893.37,884.16,874.95,874.95,Included in ER Case rate,874.95,432.3, 893.37 ,828.9
97510130,EAP,CPT® 49505,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 49505 Repair Inguinal Hernia Initial Block >5 Yr Reducible,1,1138," 1,081.10 ",1036.86," 1,081.10 "," 1,052.57 "," 1,052.57 ",Current Medicare Rates,1103.86,1092.48,1081.1,1081.1,Included in ER Case rate,1081.1,1036.86," 1,103.86 ",1024.2
97510870,EAP,CPT® 49507,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 49507 Repair Inguinal Hernia Initial Block >5 Yr,1,1281," 1,216.95 ",1165.56," 1,216.95 "," 1,183.22 "," 1,183.22 ",Current Medicare Rates,1242.57,1229.76,1216.95,1216.95,Included in ER Case rate,1216.95,1165.56," 1,242.57 ",1152.9
97510872,EAP,CPT® 49553,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 49553 Repair Femoral Hernia Initial Blocked,1,1518," 1,442.10 ",1254," 1,442.10 "," 1,273.00 "," 1,273.00 ",Current Medicare Rates,1472.46,1457.28,1442.1,1442.1,Included in ER Case rate,1442.1,1254," 1,472.46 ",1366.2
97510880,EAP,CPT® 49650,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 49650 Laparoscopy Inguinal Hernia Repair, Initial",1,1345," 1,277.75 ",858," 1,277.75 ", 871.00 , 871.00 ,Current Medicare Rates,1304.65,1291.2,1277.75,1277.75,Included in ER Case rate,1277.75,858," 1,304.65 ",1210.5
97510881,EAP,CPT® 49651,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 49651 Laparoscopy Inguinal Hernia Repair, Recurrent",1,1420," 1,349.00 ",1120.68," 1,349.00 "," 1,137.66 "," 1,137.66 ",Current Medicare Rates,1377.4,1363.2,1349,1349,Included in ER Case rate,1349,1120.68," 1,377.40 ",1278
97513061,EAP,CPT® 51500,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 51500 Removal Of Bladder Cyst,1,1528," 1,451.60 ",1243.44," 1,451.60 "," 1,262.28 "," 1,262.28 ",Current Medicare Rates,1482.16,1466.88,1451.6,1451.6,Included in ER Case rate,1451.6,1243.44," 1,482.16 ",1375.2
97511033,EAP,CPT® 55040,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 55040 Removal Of Hydrocele,1,811, 770.45 ,661.98, 770.45 , 672.01 , 672.01 ,Current Medicare Rates,786.67,778.56,770.45,770.45,Included in ER Case rate,770.45,661.98, 786.67 ,729.9
97511034,EAP,CPT® 55250,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 55250 Removal Of Sperm Duct(s),1,993, 943.35 ,448.8, 943.35 , 455.60 , 455.60 ,Current Medicare Rates,963.21,953.28,943.35,943.35,Included in ER Case rate,943.35,448.8, 963.21 ,893.7
97510371,EAP,CPT® 55874,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 55874 Tprnl Plmt Biodegrdabl Matrl W/img Guidance,1,8783," 8,343.85 ",318.78," 8,343.85 ", 323.61 , 323.61 ,Current Medicare Rates,8519.51,8431.68,8343.85,8343.85,Included in ER Case rate,8343.85,318.78," 8,519.51 ",7904.7
97511043,EAP,CPT® 56605,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr 56605 Biopsy Of Vulva/perineum, Single Lesion",1,214, 203.30 ,116.82, 203.30 , 118.59 , 118.59 ,Current Medicare Rates,207.58,205.44,203.3,203.3,Included in ER Case rate,203.3,116.82, 207.58 ,192.6
97511044,EAP,CPT® 56700,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 56700 Partial Removal Of Hymen,1,1237," 1,175.15 ",404.58," 1,175.15 ", 410.71 , 410.71 ,Current Medicare Rates,1199.89,1187.52,1175.15,1175.15,Included in ER Case rate,1175.15,404.58," 1,199.89 ",1113.3
97511045,EAP,CPT® 56740,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 56740 Remove Vagina Gland Lesion,1,713, 677.35 ,625.68, 677.35 , 635.16 , 635.16 ,Current Medicare Rates,691.61,684.48,677.35,677.35,Included in ER Case rate,677.35,625.68, 691.61 ,641.7
97511071,EAP,CPT® 57452,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 57452 Exam Of Cervix W/scope,1,257, 244.15 ,178.86, 244.15 , 181.57 , 181.57 ,Current Medicare Rates,249.29,246.72,244.15,244.15,Included in ER Case rate,244.15,178.86, 249.29 ,231.3
97511072,EAP,CPT® 57454,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 57454 Bx/curett Of Cervix W/scope,1,342, 324.90 ,261.36, 324.90 , 265.32 , 265.32 ,Current Medicare Rates,331.74,328.32,324.9,324.9,Included in ER Case rate,324.9,261.36, 331.74 ,307.8
97511079,EAP,CPT® 58120,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58120 Dilation And Curettage,1,674, 640.30 ,462.66, 640.30 , 469.67 , 469.67 ,Current Medicare Rates,653.78,647.04,640.3,640.3,Included in ER Case rate,640.3,462.66, 653.78 ,606.6
97511083,EAP,CPT® 58150,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58150 Total Hysterectomy,1,2297," 2,182.15 ",2003.76," 2,182.15 "," 2,034.12 "," 2,034.12 ",Current Medicare Rates,2228.09,2205.12,2182.15,2182.15,Included in ER Case rate,2182.15,2003.76," 2,228.09 ",2067.3
97511089,EAP,CPT® 58262,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58262 Vaginal Hysterectomy Incl Tubes/ovary(s),1,2179," 2,070.05 ",1835.46," 2,070.05 "," 1,863.27 "," 1,863.27 ",Current Medicare Rates,2113.63,2091.84,2070.05,2070.05,Included in ER Case rate,2070.05,1835.46," 2,113.63 ",1961.1
97511099,EAP,CPT® 58550,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58550 Laparo-asst Vaginal Hysterectomy,1,1976," 1,877.20 ",1745.7," 1,877.20 "," 1,772.15 "," 1,772.15 ",Current Medicare Rates,1916.72,1896.96,1877.2,1877.2,Included in ER Case rate,1877.2,1745.7," 1,916.72 ",1778.4
97511101,EAP,CPT® 58553,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58553 Laparo-vaginal Hysterectomy Complex,1,2687," 2,552.65 ",2214.96," 2,552.65 "," 2,248.52 "," 2,248.52 ",Current Medicare Rates,2606.39,2579.52,2552.65,2552.65,Included in ER Case rate,2552.65,2214.96," 2,606.39 ",2418.3
97513094,EAP,CPT® 58559,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58559 Hysteroscopy Lysis,1,807, 766.65 ,557.7, 766.65 , 566.15 , 566.15 ,Current Medicare Rates,782.79,774.72,766.65,766.65,Included in ER Case rate,766.65,557.7, 782.79 ,726.3
97511561,EAP,CPT® 58570,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58570 Tlh Uterus 250 G Or Less,1,2897," 2,752.15 ",1599.18," 2,752.15 "," 1,623.41 "," 1,623.41 ",Current Medicare Rates,2810.09,2781.12,2752.15,2752.15,Included in ER Case rate,2752.15,1599.18," 2,810.09 ",2607.3
97511562,EAP,CPT® 58571,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58571 Tlh W/t/o 250 G Or Less,1,"2,342.00"," 2,224.90 ",1795.2," 2,224.90 "," 1,822.40 "," 1,822.40 ",Current Medicare Rates,2271.74,2248.32,2224.9,2224.9,Included in ER Case rate,2224.9,1795.2," 2,271.74 ",2107.8
97510375,EAP,CPT® 58575,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58575 Laps Tot Hyst Resj Mal,1,4466," 4,242.70 ",3808.86," 4,242.70 "," 3,866.57 "," 3,866.57 ",Current Medicare Rates,4332.02,4287.36,4242.7,4242.7,Included in ER Case rate,4242.7,3808.86," 4,332.02 ",4019.4
97511107,EAP,CPT® 58611,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58611 Ligate Oviduct(s) Add-on,1,202, 191.90 ,149.16, 191.90 , 151.42 , 151.42 ,Current Medicare Rates,195.94,193.92,191.9,191.9,Included in ER Case rate,191.9,149.16, 195.94 ,181.8
97511109,EAP,CPT® 58660,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58660 Laparoscopy Lysis,1,1596," 1,516.20 ",1349.7," 1,516.20 "," 1,370.15 "," 1,370.15 ",Current Medicare Rates,1548.12,1532.16,1516.2,1516.2,Included in ER Case rate,1516.2,1349.7," 1,548.12 ",1436.4
97511110,EAP,CPT® 58661,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58661 Laparoscopy Remove Adnexa,1,1609," 1,528.55 ",1290.96," 1,528.55 "," 1,310.52 "," 1,310.52 ",Current Medicare Rates,1560.73,1544.64,1528.55,1528.55,Included in ER Case rate,1528.55,1290.96," 1,560.73 ",1448.1
97511112,EAP,CPT® 58670,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58670 Laparoscopy Tubal Cautery,1,949, 901.55 ,737.88, 901.55 , 749.06 , 749.06 ,Current Medicare Rates,920.53,911.04,901.55,901.55,Included in ER Case rate,901.55,737.88, 920.53 ,854.1
97511113,EAP,CPT® 58671,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58671 Laparoscopy Tubal Block,1,816, 775.20 ,737.88, 775.20 , 749.06 , 749.06 ,Current Medicare Rates,791.52,783.36,775.2,775.2,Included in ER Case rate,775.2,737.88, 791.52 ,734.4
97511116,EAP,CPT® 58720,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58720 Removal Of Ovary/tube(s),1,1748," 1,660.60 ",1501.5," 1,660.60 "," 1,524.25 "," 1,524.25 ",Current Medicare Rates,1695.56,1678.08,1660.6,1660.6,Included in ER Case rate,1660.6,1501.5," 1,695.56 ",1573.2
97511117,EAP,CPT® 58940,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 58940 Removal Of Ovary(s),1,1243," 1,180.85 ",1104.84," 1,180.85 "," 1,121.58 "," 1,121.58 ",Current Medicare Rates,1205.71,1193.28,1180.85,1180.85,Included in ER Case rate,1180.85,1104.84," 1,205.71 ",1118.7
97510605,EAP,CPT® 59160,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 59160 D & C After Delivery,1,490, 465.50 ,376.2, 465.50 , 381.90 , 381.90 ,Current Medicare Rates,475.3,470.4,465.5,465.5,Included in ER Case rate,465.5,376.2, 475.30 ,441
97511121,EAP,CPT® 60100,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 60100 Biopsy Of Thyroid,1,401, 380.95 ,150.48, 380.95 , 152.76 , 152.76 ,Current Medicare Rates,388.97,384.96,380.95,380.95,Included in ER Case rate,380.95,150.48, 388.97 ,360.9
97511127,EAP,CPT® 60240,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 60240 Removal Of Thyroid,1,2218," 2,107.10 ",1812.36," 2,107.10 "," 1,839.82 "," 1,839.82 ",Current Medicare Rates,2151.46,2129.28,2107.1,2107.1,Included in ER Case rate,2107.1,1812.36," 2,151.46 ",1996.2
97510667,EAP,CPT® 64455,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 64455 Inject Plantar Common Digital Nerve,1,170, 161.50 ,65.34, 161.50 , 66.33 , 66.33 ,Current Medicare Rates,164.9,163.2,161.5,161.5,Included in ER Case rate,161.5,65.34, 164.90 ,153
97513440,EAP,CPT® 64505,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 64505 N Block Spenopalatine Gangl,1,330, 313.50 ,205.26, 313.50 , 208.37 , 208.37 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,205.26, 320.10 ,297
97511173,EAP,CPT® 64722,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 64722 Relieve Pressure On Nerve(s),1,884, 839.80 ,726, 839.80 , 737.00 , 737.00 ,Current Medicare Rates,857.48,848.64,839.8,839.8,Included in ER Case rate,839.8,726, 857.48 ,795.6
97510386,EAP,CPT® 64912,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 64912 Nerve Repair W/nrv Algrft 1st,1,1865," 1,771.75 ",1768.14," 1,771.75 "," 1,794.93 "," 1,794.93 ",Current Medicare Rates,1809.05,1790.4,1771.75,1771.75,Included in ER Case rate,1771.75,1768.14," 1,809.05 ",1678.5
97510398,EAP,CPT® 64913,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr 64913 Nervev Repair W/nrv Algrft Ea Addl,1,378, 359.10 ,338.58, 359.10 , 343.71 , 343.71 ,Current Medicare Rates,366.66,362.88,359.1,359.1,Included in ER Case rate,359.1,338.58, 366.66 ,340.2
97510300,EAP,CPT® 38222,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr Dx Bone Marrow Bx & Aspir,1,402, 381.90 ,147.18, 381.90 , 149.41 , 149.41 ,Current Medicare Rates,389.94,385.92,381.9,381.9,Included in ER Case rate,381.9,147.18, 389.94 ,361.8
97510012,EAP,HCPCS G0105,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr G0105 Colorectal Scrn; Hi Risk Ind,1,725, 688.75 ,357.72, 688.75 , 363.14 , 363.14 ,Current Medicare Rates,703.25,696,688.75,688.75,Included in ER Case rate,688.75,357.72, 703.25 ,652.5
97510013,EAP,HCPCS G0121,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr G0121 Colorectal Scrn; Not Hi Risk Ind,1,852, 809.40 ,358.38, 809.40 , 363.81 , 363.81 ,Current Medicare Rates,826.44,817.92,809.4,809.4,Included in ER Case rate,809.4,358.38, 826.44 ,766.8
97510689,EAP,HCPCS G0516,,0975 - PROFESSIONAL FEES - OPERATING ROOM,"Hc Pr G0516 Insert Drug Del Implant, >4",1,553, 525.35 ,188.76, 525.35 , 191.62 , 191.62 ,Current Medicare Rates,536.41,530.88,525.35,525.35,Included in ER Case rate,525.35,188.76, 536.41 ,497.7
97510690,EAP,HCPCS G0517,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr G0517 Remove Drug Implant,1,609, 578.55 ,214.5, 578.55 , 217.75 , 217.75 ,Current Medicare Rates,590.73,584.64,578.55,578.55,Included in ER Case rate,578.55,214.5, 590.73 ,548.1
97510691,EAP,HCPCS G0518,,0975 - PROFESSIONAL FEES - OPERATING ROOM,Hc Pr G0518 Remove W Insert Drug Implant,1,1052, 999.40 ,352.44, 999.40 , 357.78 , 357.78 ,Current Medicare Rates,1020.44,1009.92,999.4,999.4,Included in ER Case rate,999.4,352.44," 1,020.44 ",946.8
97610022,EAP,CPT® 93017,,0976 - PROFESSIONAL FEES - RESPIRATORY THERAPY,Hc Pr 93017 Cardio Stress Test Tracing Only,1,102, 96.90 ,70.62, 96.90 , 71.69 , 71.69 ,Current Medicare Rates,98.94,97.92,96.9,96.9,Included in ER Case rate,96.9,70.62, 98.94 ,91.8
97610016,EAP,CPT® 94010,,0976 - PROFESSIONAL FEES - RESPIRATORY THERAPY,Hc Pr 94010 Spirometry,1,81, 76.95 ,52.8, 76.95 , 53.60 , 53.60 ,Current Medicare Rates,78.57,77.76,76.95,76.95,Included in ER Case rate,76.95,52.8, 78.57 ,72.9
97610003,EAP,CPT® 94060,,0976 - PROFESSIONAL FEES - RESPIRATORY THERAPY,Hc Pr 94060 Spirometry Pre Post Bronchodilator,1,140, 133.00 ,75.9, 133.00 , 77.05 , 77.05 ,Current Medicare Rates,135.8,134.4,133,133,Included in ER Case rate,133,75.9, 135.80 ,126
98100002,EAP,17250,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 17250 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE [17250] CDM,1,203, 192.85 ,73.26, 192.85 , 74.37 , 74.37 ,Current Medicare Rates,196.91,194.88,192.85,192.85,Included in ER Case rate,192.85,73.26, 196.91 ,182.7
98110936,EAP,29086,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 29086 ER CAST FINGER,1,193, 183.35 ,97.02, 183.35 , 98.49 , 98.49 ,Current Medicare Rates,187.21,185.28,183.35,183.35,Included in ER Case rate,183.35,97.02, 187.21 ,173.7
98110474,EAP,29305,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 29305 APPLICATION OF HIP CAST,1,612, 581.40 ,311.52, 581.40 , 316.24 , 316.24 ,Current Medicare Rates,593.64,587.52,581.4,581.4,Included in ER Case rate,581.4,311.52, 593.64 ,550.8
98110478,EAP,29445,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 29445 APPLY RIGID LEG CAST,1,329, 312.55 ,192.06, 312.55 , 194.97 , 194.97 ,Current Medicare Rates,319.13,315.84,312.55,312.55,Included in ER Case rate,312.55,192.06, 319.13 ,296.1
98110118,EAP,29520,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 29520 STRAPPING OF HIP,1,100, 95.00 ,35.64, 95.00 , 36.18 , 36.18 ,Current Medicare Rates,97,96,95,95,Included in ER Case rate,95,35.64, 97.00 ,90
98110626,EAP,29530,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 29530 STRAPPING OF KNEE,1,86, 81.70 ,35.64, 81.70 , 36.18 , 36.18 ,Current Medicare Rates,83.42,82.56,81.7,81.7,Included in ER Case rate,81.7,35.64, 83.42 ,77.4
98110484,EAP,29730,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 29730 WINDOWING OF CAST,1,165, 156.75 ,87.12, 156.75 , 88.44 , 88.44 ,Current Medicare Rates,160.05,158.4,156.75,156.75,Included in ER Case rate,156.75,87.12, 160.05 ,148.5
98110955,EAP,76536,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 76536 HEAD AND NECK SOFT TISSUES,1,259, 246.05 ,221.1, 246.05 , 224.45 , 224.45 ,Current Medicare Rates,251.23,248.64,246.05,246.05,Included in ER Case rate,246.05,221.1, 251.23 ,233.1
98110229,EAP,CPT® 10060,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10060 Drainage Of Skin Abscess Simple Or Single,1,344, 326.80 ,207.24, 326.80 , 210.38 , 210.38 ,Current Medicare Rates,333.68,330.24,326.8,326.8,Included in ER Case rate,326.8,207.24, 333.68 ,309.6
98110231,EAP,CPT® 10061,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10061 Drainage Of Skin Abscess Complicated Or Multiple,1,607, 576.65 ,361.02, 576.65 , 366.49 , 366.49 ,Current Medicare Rates,588.79,582.72,576.65,576.65,Included in ER Case rate,576.65,361.02, 588.79 ,546.3
98110232,EAP,CPT® 10080,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10080 Drainage Of Pilonidal Cyst Simple,1,337, 320.15 ,205.92, 320.15 , 209.04 , 209.04 ,Current Medicare Rates,326.89,323.52,320.15,320.15,Included in ER Case rate,320.15,205.92, 326.89 ,303.3
98110233,EAP,CPT® 10081,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10081 Drainage Of Pilonidal Cyst Complicated,1,649, 616.55 ,336.6, 616.55 , 341.70 , 341.70 ,Current Medicare Rates,629.53,623.04,616.55,616.55,Included in ER Case rate,616.55,336.6, 629.53 ,584.1
98110234,EAP,CPT® 10120,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10120 Remove Foreign Body Simple,1,449, 426.55 ,207.24, 426.55 , 210.38 , 210.38 ,Current Medicare Rates,435.53,431.04,426.55,426.55,Included in ER Case rate,426.55,207.24, 435.53 ,404.1
98110235,EAP,CPT® 10121,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10121 Remove Foreign Body Complicated,1,719, 683.05 ,361.02, 683.05 , 366.49 , 366.49 ,Current Medicare Rates,697.43,690.24,683.05,683.05,Included in ER Case rate,683.05,361.02, 697.43 ,647.1
98110236,EAP,CPT® 10140,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10140 Drainage Of Hematoma/fluid,1,504, 478.80 ,231.66, 478.80 , 235.17 , 235.17 ,Current Medicare Rates,488.88,483.84,478.8,478.8,Included in ER Case rate,478.8,231.66, 488.88 ,453.6
98110238,EAP,CPT® 10160,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 10160 Puncture Drainage Of Lesion,1,383, 363.85 ,190.08, 363.85 , 192.96 , 192.96 ,Current Medicare Rates,371.51,367.68,363.85,363.85,Included in ER Case rate,363.85,190.08, 371.51 ,344.7
98110240,EAP,CPT® 11000,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11000 Debride Infected Skin,1,148, 140.60 ,52.8, 140.60 , 53.60 , 53.60 ,Current Medicare Rates,143.56,142.08,140.6,140.6,Included in ER Case rate,140.6,52.8, 143.56 ,133.2
98110242,EAP,CPT® 11042,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11042 Deb Subq Tissue 20 Sq Cm/<,1,303, 287.85 ,116.82, 287.85 , 118.59 , 118.59 ,Current Medicare Rates,293.91,290.88,287.85,287.85,Included in ER Case rate,287.85,116.82, 293.91 ,272.7
98110249,EAP,CPT® 11401,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11401 Exc Tr-ext B9+marg 0.6-1 Cm,1,436, 414.20 ,209.22, 414.20 , 212.39 , 212.39 ,Current Medicare Rates,422.92,418.56,414.2,414.2,Included in ER Case rate,414.2,209.22, 422.92 ,392.4
98110250,EAP,CPT® 11720,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11720 Debride Nail 1-5,1,118, 112.10 ,28.38, 112.10 , 28.81 , 28.81 ,Current Medicare Rates,114.46,113.28,112.1,112.1,Included in ER Case rate,112.1,28.38, 114.46 ,106.2
98110251,EAP,CPT® 11730,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11730 Removal Of Nail Plate,1,325, 308.75 ,104.94, 308.75 , 106.53 , 106.53 ,Current Medicare Rates,315.25,312,308.75,308.75,Included in ER Case rate,308.75,104.94, 315.25 ,292.5
98110253,EAP,CPT® 11740,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11740 Drain Blood From Under Nail,1,157, 149.15 ,62.7, 149.15 , 63.65 , 63.65 ,Current Medicare Rates,152.29,150.72,149.15,149.15,Included in ER Case rate,149.15,62.7, 152.29 ,141.3
98110254,EAP,CPT® 11750,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11750 Removal Of Nail Bed,1,607, 576.65 ,197.34, 576.65 , 200.33 , 200.33 ,Current Medicare Rates,588.79,582.72,576.65,576.65,Included in ER Case rate,576.65,197.34, 588.79 ,546.3
98110256,EAP,CPT® 11760,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11760 Repair Of Nail Bed,1,484, 459.80 ,217.14, 459.80 , 220.43 , 220.43 ,Current Medicare Rates,469.48,464.64,459.8,459.8,Included in ER Case rate,459.8,217.14, 469.48 ,435.6
98110258,EAP,CPT® 11765,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 11765 Excision Of Nail Fold Toe,1,516, 490.20 ,180.84, 490.20 , 183.58 , 183.58 ,Current Medicare Rates,500.52,495.36,490.2,490.2,Included in ER Case rate,490.2,180.84, 500.52 ,464.4
98110259,EAP,CPT® 12001,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12001 Repair Superficial Wound(s)< 2.5cm Slp Nk Ax Exgen Trnk Ex,1,317, 301.15 ,88.44, 301.15 , 89.78 , 89.78 ,Current Medicare Rates,307.49,304.32,301.15,301.15,Included in ER Case rate,301.15,88.44, 307.49 ,285.3
98110260,EAP,CPT® 12002,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12002 Repair Superficial Wound(s) 2.6 To 7.5cm Slp Nk Ax Exgen T,1,419, 398.05 ,115.5, 398.05 , 117.25 , 117.25 ,Current Medicare Rates,406.43,402.24,398.05,398.05,Included in ER Case rate,398.05,115.5, 406.43 ,377.1
98110261,EAP,CPT® 12004,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12004 Repair Superficial Wound(s)7.6 To 12.5cm Slp Nk Ax Exgen T,1,519, 493.05 ,143.22, 493.05 , 145.39 , 145.39 ,Current Medicare Rates,503.43,498.24,493.05,493.05,Included in ER Case rate,493.05,143.22, 503.43 ,467.1
98110262,EAP,CPT® 12005,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12005 Repair Superficial Wound(s)12.6 To 20.0cm Slp Nk Ax Exgen,1,764, 725.80 ,185.46, 725.80 , 188.27 , 188.27 ,Current Medicare Rates,741.08,733.44,725.8,725.8,Included in ER Case rate,725.8,185.46, 741.08 ,687.6
98110263,EAP,CPT® 12006,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12006 Repair Superficial Wound(s) 20.1-30.0cm Slp Nk Ax Exgen Tr,1,830, 788.50 ,228.36, 788.50 , 231.82 , 231.82 ,Current Medicare Rates,805.1,796.8,788.5,788.5,Included in ER Case rate,788.5,228.36, 805.10 ,747
98110265,EAP,CPT® 12011,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12011 Repair Superficial Wound(s) <2.5 Face Ers Eyld Nse Lps Muc,1,378, 359.10 ,108.24, 359.10 , 109.88 , 109.88 ,Current Medicare Rates,366.66,362.88,359.1,359.1,Included in ER Case rate,359.1,108.24, 366.66 ,340.2
98110266,EAP,CPT® 12013,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12013 Repair Superficial Wound(s) 2.6 To 5.0cm Face Ers Eyld Nse,1,516, 490.20 ,114.84, 490.20 , 116.58 , 116.58 ,Current Medicare Rates,500.52,495.36,490.2,490.2,Included in ER Case rate,490.2,114.84, 500.52 ,464.4
98110267,EAP,CPT® 12014,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12014 Repair Superficial Wound(s) 5.1 To 7.5cm Face Ers Eyld Nse,1,585, 555.75 ,146.52, 555.75 , 148.74 , 148.74 ,Current Medicare Rates,567.45,561.6,555.75,555.75,Included in ER Case rate,555.75,146.52, 567.45 ,526.5
98110268,EAP,CPT® 12015,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12015 Repair Superficial Wound(s) 7.6 To 12.5cm Face Ers Eyld Ns,1,719, 683.05 ,184.8, 683.05 , 187.60 , 187.60 ,Current Medicare Rates,697.43,690.24,683.05,683.05,Included in ER Case rate,683.05,184.8, 697.43 ,647.1
98110269,EAP,CPT® 12016,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12016 Repair Superficial Wound(s) 12.6 To 20.0cm Face Ers Eyld N,1,988, 938.60 ,250.8, 938.60 , 254.60 , 254.60 ,Current Medicare Rates,958.36,948.48,938.6,938.6,Included in ER Case rate,938.6,250.8, 958.36 ,889.2
98110272,EAP,CPT® 12020,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12020 Closure Of Split Wound Simple Closure,1,616, 585.20 ,370.92, 585.20 , 376.54 , 376.54 ,Current Medicare Rates,597.52,591.36,585.2,585.2,Included in ER Case rate,585.2,370.92, 597.52 ,554.4
98110274,EAP,CPT® 12031,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12031 Intmd Wnd Repair S/tr/ext Up To 2.5cm,1,456, 433.20 ,297.66, 433.20 , 302.17 , 302.17 ,Current Medicare Rates,442.32,437.76,433.2,433.2,Included in ER Case rate,433.2,297.66, 442.32 ,410.4
98110275,EAP,CPT® 12032,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12032 Intmd Wnd Repair S/tr/ext 2.6 To 7.5cm,1,629, 597.55 ,372.24, 597.55 , 377.88 , 377.88 ,Current Medicare Rates,610.13,603.84,597.55,597.55,Included in ER Case rate,597.55,372.24, 610.13 ,566.1
98110276,EAP,CPT® 12034,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12034 Intmd Wnd Repair S/tr/ext 7.6 To 12.5cm,1,793, 753.35 ,402.6, 753.35 , 408.70 , 408.70 ,Current Medicare Rates,769.21,761.28,753.35,753.35,Included in ER Case rate,753.35,402.6, 769.21 ,713.7
98110277,EAP,CPT® 12035,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12035 Intmd Wnd Repair S/tr/ext 12.6 To 20.0cm,1,917, 871.15 ,473.88, 871.15 , 481.06 , 481.06 ,Current Medicare Rates,889.49,880.32,871.15,871.15,Included in ER Case rate,871.15,473.88, 889.49 ,825.3
98110278,EAP,CPT® 12036,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12036 Intmd Wnd Repair S/tr/ext 20.1 To 30.0cm,1,1048, 995.60 ,553.08, 995.60 , 561.46 , 561.46 ,Current Medicare Rates,1016.56,1006.08,995.6,995.6,Included in ER Case rate,995.6,553.08," 1,016.56 ",943.2
98110280,EAP,CPT® 12041,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12041 Intmd Wnd Repair N-hf/genit Up To 2.5cm,1,708, 672.60 ,284.46, 672.60 , 288.77 , 288.77 ,Current Medicare Rates,686.76,679.68,672.6,672.6,Included in ER Case rate,672.6,284.46, 686.76 ,637.2
98110281,EAP,CPT® 12042,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12042 Intmd Wnd Repair N-hg/genit 2.6 To 7.5cm,1,649, 616.55 ,382.8, 616.55 , 388.60 , 388.60 ,Current Medicare Rates,629.53,623.04,616.55,616.55,Included in ER Case rate,616.55,382.8, 629.53 ,584.1
98110282,EAP,CPT® 12044,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12044 Intmd Wnd Repair N-hg/genit 7.6 To 12.5cm,1,816, 775.20 ,419.1, 775.20 , 425.45 , 425.45 ,Current Medicare Rates,791.52,783.36,775.2,775.2,Included in ER Case rate,775.2,419.1, 791.52 ,734.4
98110284,EAP,CPT® 12045,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12045 Intmd Wnd Repair N-hg/genit 12.6 To 20.0cm,1,981.00, 931.95 ,540.54, 931.95 , 548.73 , 548.73 ,Current Medicare Rates,951.57,941.76,931.95,931.95,Included in ER Case rate,931.95,540.54, 951.57 ,882.9
98110285,EAP,CPT® 12046,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12046 Intmd Wnd Repair N-hg/genit 20.1-30.0cm,1,1287," 1,222.65 ",626.34," 1,222.65 ", 635.83 , 635.83 ,Current Medicare Rates,1248.39,1235.52,1222.65,1222.65,Included in ER Case rate,1222.65,626.34," 1,248.39 ",1158.3
98110287,EAP,CPT® 12051,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12051 Intmd Wnd Repair Face/mm <2.5 Cm,1,622, 590.90 ,332.64, 590.90 , 337.68 , 337.68 ,Current Medicare Rates,603.34,597.12,590.9,590.9,Included in ER Case rate,590.9,332.64, 603.34 ,559.8
98110288,EAP,CPT® 12052,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12052 Intmd Wnd Repair Face/mm 2.6 To 5.0cm,1,860, 817.00 ,391.38, 817.00 , 397.31 , 397.31 ,Current Medicare Rates,834.2,825.6,817,817,Included in ER Case rate,817,391.38, 834.20 ,774
98110289,EAP,CPT® 12053,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,HC PR 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM,1,856, 813.20 ,422.4, 813.20 , 428.80 , 428.80 ,Current Medicare Rates,830.32,821.76,813.2,813.2,Included in ER Case rate,813.2,422.4, 830.32 ,770.4
98110290,EAP,CPT® 12054,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 12054 Intmd Wnd Repair Face/mm 7.5 To 12.5cm,1,1096," 1,041.20 ",431.64," 1,041.20 ", 438.18 , 438.18 ,Current Medicare Rates,1063.12,1052.16,1041.2,1041.2,Included in ER Case rate,1041.2,431.64," 1,063.12 ",986.4
98110294,EAP,CPT® 13100,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 13100 Repair Of Wound Or Lesion 1.1 To 2.5cm Complex, Trunk",1,702, 666.90 ,392.7, 666.90 , 398.65 , 398.65 ,Current Medicare Rates,680.94,673.92,666.9,666.9,Included in ER Case rate,666.9,392.7, 680.94 ,631.8
98110295,EAP,CPT® 13101,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 13101 Repair Of Wound Or Lesion 2.6 To 7.5cm Complex, Trunk",1,1125," 1,068.75 ",484.44," 1,068.75 ", 491.78 , 491.78 ,Current Medicare Rates,1091.25,1080,1068.75,1068.75,Included in ER Case rate,1068.75,484.44," 1,091.25 ",1012.5
98110297,EAP,CPT® 13120,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 13120 Repair Of Wound Or Lesion 1.1 To 2.5cm Complex, Sclp Arm L",1,825, 783.75 ,454.74, 783.75 , 461.63 , 461.63 ,Current Medicare Rates,800.25,792,783.75,783.75,Included in ER Case rate,783.75,454.74, 800.25 ,742.5
98110298,EAP,CPT® 13121,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 13121 Repair Of Wound Or Lesion 2.6 To 7.5cm Complex, Sclp Arm L",1,1383," 1,313.85 ",502.92," 1,313.85 ", 510.54 , 510.54 ,Current Medicare Rates,1341.51,1327.68,1313.85,1313.85,Included in ER Case rate,1313.85,502.92," 1,341.51 ",1244.7
98110299,EAP,CPT® 13122,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 13122 Repair Wound/lesion Add-on 5cm Or Less Complex, Sclp Arm L",1,314, 298.30 ,161.7, 298.30 , 164.15 , 164.15 ,Current Medicare Rates,304.58,301.44,298.3,298.3,Included in ER Case rate,298.3,161.7, 304.58 ,282.6
98110501,EAP,CPT® 13131,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 13131 Repair Of Wound Or Lesion 1.1 To 2.5cm Cmplx, Frhd Cks Shn",1,1065," 1,011.75 ",472.56," 1,011.75 ", 479.72 , 479.72 ,Current Medicare Rates,1033.05,1022.4,1011.75,1011.75,Included in ER Case rate,1011.75,472.56," 1,033.05 ",958.5
98110502,EAP,CPT® 13132,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 13132 Repair Of Wound Or Lesion 2.6 To 7.5cm Cmplx, Frhd Cks Shn",1,1822," 1,730.90 ",592.02," 1,730.90 ", 600.99 , 600.99 ,Current Medicare Rates,1767.34,1749.12,1730.9,1730.9,Included in ER Case rate,1730.9,592.02," 1,767.34 ",1639.8
98110505,EAP,CPT® 13151,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 13151 Repair Of Wound Or Lesion 1.1 To 2.5cm Cmplx Eyld Ns Ers L,1,1320," 1,254.00 ",544.5," 1,254.00 ", 552.75 , 552.75 ,Current Medicare Rates,1280.4,1267.2,1254,1254,Included in ER Case rate,1254,544.5," 1,280.40 ",1188
98110506,EAP,CPT® 13152,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 13152 Repair Of Wound Or Lesion 2.6 To 7.5cm Cmplx Eyld Ns Ers L,1,2275," 2,161.25 ",656.04," 2,161.25 ", 665.98 , 665.98 ,Current Medicare Rates,2206.75,2184,2161.25,2161.25,Included in ER Case rate,2161.25,656.04," 2,206.75 ",2047.5
98110509,EAP,CPT® 16000,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 16000 Initial Treatment Of Burn(s) 1st Deg Local Tx,1,191, 181.45 ,89.76, 181.45 , 91.12 , 91.12 ,Current Medicare Rates,185.27,183.36,181.45,181.45,Included in ER Case rate,181.45,89.76, 185.27 ,171.9
98110510,EAP,CPT® 16020,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 16020 Dress/debrid P-thick Burn S <5% Tbsa,1,281, 266.95 ,108.9, 266.95 , 110.55 , 110.55 ,Current Medicare Rates,272.57,269.76,266.95,266.95,Included in ER Case rate,266.95,108.9, 272.57 ,252.9
98110511,EAP,CPT® 16025,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 16025 Dress/debrid P-thick Burn M 5-10% Tbsa,1,353, 335.35 ,216.48, 335.35 , 219.76 , 219.76 ,Current Medicare Rates,342.41,338.88,335.35,335.35,Included in ER Case rate,335.35,216.48, 342.41 ,317.7
98110512,EAP,CPT® 16030,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 16030 Dress/debrid P-thick Burn L >10% Tbsa,1,449, 426.55 ,258.06, 426.55 , 261.97 , 261.97 ,Current Medicare Rates,435.53,431.04,426.55,426.55,Included in ER Case rate,426.55,258.06, 435.53 ,404.1
98110514,EAP,CPT® 19000,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 19000 Drainage Of Breast Lesion,1,273, 259.35 ,83.16, 259.35 , 84.42 , 84.42 ,Current Medicare Rates,264.81,262.08,259.35,259.35,Included in ER Case rate,259.35,83.16, 264.81 ,245.7
98110519,EAP,CPT® 20102,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20102 Explore Wound Abdomen,1,2410," 2,289.50 ",500.28," 2,289.50 ", 507.86 , 507.86 ,Current Medicare Rates,2337.7,2313.6,2289.5,2289.5,Included in ER Case rate,2289.5,500.28," 2,337.70 ",2169
98110520,EAP,CPT® 20103,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20103 Explore Wound Extremity,1,2185," 2,075.75 ",679.8," 2,075.75 ", 690.10 , 690.10 ,Current Medicare Rates,2119.45,2097.6,2075.75,2075.75,Included in ER Case rate,2075.75,679.8," 2,119.45 ",1966.5
98110521,EAP,CPT® 20520,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 20520 Removal Of Foreign Body Musc, Simp",1,576, 547.20 ,290.4, 547.20 , 294.80 , 294.80 ,Current Medicare Rates,558.72,552.96,547.2,547.2,Included in ER Case rate,547.2,290.4, 558.72 ,518.4
98110522,EAP,CPT® 20525,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20525 Removal Of Foreign Body Complex,1,1295," 1,230.25 ",487.74," 1,230.25 ", 495.13 , 495.13 ,Current Medicare Rates,1256.15,1243.2,1230.25,1230.25,Included in ER Case rate,1230.25,487.74," 1,256.15 ",1165.5
98110523,EAP,CPT® 20550,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20550 Inj Tendon Sheath/ligament,1,176.00, 167.20 ,76.56, 167.20 , 77.72 , 77.72 ,Current Medicare Rates,170.72,168.96,167.2,167.2,Included in ER Case rate,167.2,76.56, 170.72 ,158.4
98110525,EAP,CPT® 20552,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20552 Inj Trigger Point 1/2 Muscl,1,212, 201.40 ,72.6, 201.40 , 73.70 , 73.70 ,Current Medicare Rates,205.64,203.52,201.4,201.4,Included in ER Case rate,201.4,72.6, 205.64 ,190.8
98110526,EAP,CPT® 20553,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20553 Inject Trigger Points =/> 3,1,535, 508.25 ,83.16, 508.25 , 84.42 , 84.42 ,Current Medicare Rates,518.95,513.6,508.25,508.25,Included in ER Case rate,508.25,83.16, 518.95 ,481.5
98110528,EAP,CPT® 20600,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20600 Drain/inject Joint/bursa Small W/o Ultrasound Guidance,1,234, 222.30 ,69.3, 222.30 , 70.35 , 70.35 ,Current Medicare Rates,226.98,224.64,222.3,222.3,Included in ER Case rate,222.3,69.3, 226.98 ,210.6
98110529,EAP,CPT® 20605,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20605 Drain/inject Joint/bursa Interm W/o Ultrasound Guidance,1,136.00, 129.20 ,72.6, 129.20 , 73.70 , 73.70 ,Current Medicare Rates,131.92,130.56,129.2,129.2,Included in ER Case rate,129.2,72.6, 131.92 ,122.4
98110531,EAP,CPT® 20610,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 20610 Drain/inject Joint/bursa Major,1,179.00, 170.05 ,88.44, 170.05 , 89.78 , 89.78 ,Current Medicare Rates,173.63,171.84,170.05,170.05,Included in ER Case rate,170.05,88.44, 173.63 ,161.1
98110541,EAP,CPT® 21480,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 21480 Reset Dislocated Jaw Uncomplicated,1,504.00, 478.80 ,61.38, 478.80 , 62.31 , 62.31 ,Current Medicare Rates,488.88,483.84,478.8,478.8,Included in ER Case rate,478.8,61.38, 488.88 ,453.6
98110544,EAP,CPT® 21820,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 21820 Treat Sternum Fracture,1,744, 706.80 ,298.32, 706.80 , 302.84 , 302.84 ,Current Medicare Rates,721.68,714.24,706.8,706.8,Included in ER Case rate,706.8,298.32, 721.68 ,669.6
98110547,EAP,22310,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 22310 Treat Spine Fracture,1,2112," 2,006.40 ",593.34," 2,006.40 ", 602.33 , 602.33 ,Current Medicare Rates,2048.64,2027.52,2006.4,2006.4,Included in ER Case rate,2006.4,593.34," 2,048.64 ",1900.8
98110550,EAP,CPT® 23330,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23330 Remove Shoulder Foreign Body,1,579, 550.05 ,331.98, 550.05 , 337.01 , 337.01 ,Current Medicare Rates,561.63,555.84,550.05,550.05,Included in ER Case rate,550.05,331.98, 561.63 ,521.1
98110551,EAP,CPT® 23500,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23500 Treat Clavicle Fracture W/o Manip,1,739, 702.05 ,465.3, 702.05 , 472.35 , 472.35 ,Current Medicare Rates,716.83,709.44,702.05,702.05,Included in ER Case rate,702.05,465.3, 716.83 ,665.1
98110553,EAP,CPT® 23505,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23505 Treat Clavicle Fracture W/manip,1,1240," 1,178.00 ",675.18," 1,178.00 ", 685.41 , 685.41 ,Current Medicare Rates,1202.8,1190.4,1178,1178,Included in ER Case rate,1178,675.18," 1,202.80 ",1116
98110559,EAP,CPT® 23545,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23545 Treat Clavicle Dislocation Ac Jt Dislo W/man,1,958, 910.10 ,655.38, 910.10 , 665.31 , 665.31 ,Current Medicare Rates,929.26,919.68,910.1,910.1,Included in ER Case rate,910.1,655.38, 929.26 ,862.2
98110563,EAP,CPT® 23600,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23600 Treat Humerus Fracture W/o Manip,1,"1,135.00"," 1,078.25 ",642.18," 1,078.25 ", 651.91 , 651.91 ,Current Medicare Rates,1100.95,1089.6,1078.25,1078.25,Included in ER Case rate,1078.25,642.18," 1,100.95 ",1021.5
98110570,EAP,CPT® 23650,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23650 Treat Shoulder Dislocation W/manip,1,"1,163.00"," 1,104.85 ",607.86," 1,104.85 ", 617.07 , 617.07 ,Current Medicare Rates,1128.11,1116.48,1104.85,1104.85,Included in ER Case rate,1104.85,607.86," 1,128.11 ",1046.7
98110572,EAP,CPT® 23655,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23655 Treat Shoulder Dislocation W/manip & Annes,1,"1,454.00"," 1,381.30 ",820.38," 1,381.30 ", 832.81 , 832.81 ,Current Medicare Rates,1410.38,1395.84,1381.3,1381.3,Included in ER Case rate,1381.3,820.38," 1,410.38 ",1308.6
98110574,EAP,CPT® 23665,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23665 Cltx Shoulder Dislc W/fx Humeral Tubrst W/manj,1,"1,168.00"," 1,109.60 ",806.52," 1,109.60 ", 818.74 , 818.74 ,Current Medicare Rates,1132.96,1121.28,1109.6,1109.6,Included in ER Case rate,1109.6,806.52," 1,132.96 ",1051.2
98110578,EAP,CPT® 23931,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 23931 Drainage Of Arm Bursa,1,1071," 1,017.45 ",320.76," 1,017.45 ", 325.62 , 325.62 ,Current Medicare Rates,1038.87,1028.16,1017.45,1017.45,Included in ER Case rate,1017.45,320.76," 1,038.87 ",963.9
98110701,EAP,CPT® 24500,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24500 Treat Humerus Fx W/o Manip,1,1246," 1,183.70 ",678.48," 1,183.70 ", 688.76 , 688.76 ,Current Medicare Rates,1208.62,1196.16,1183.7,1183.7,Included in ER Case rate,1183.7,678.48," 1,208.62 ",1121.4
98110703,EAP,CPT® 24505,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24505 Treat Humerus Fx W/manip,1,"1,108.00"," 1,052.60 ",912.78," 1,052.60 ", 926.61 , 926.61 ,Current Medicare Rates,1074.76,1063.68,1052.6,1052.6,Included in ER Case rate,1052.6,912.78," 1,074.76 ",997.2
98110704,EAP,CPT® 24530,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24530 Treat Humerus Fracture,1,982, 932.90 ,713.46, 932.90 , 724.27 , 724.27 ,Current Medicare Rates,952.54,942.72,932.9,932.9,Included in ER Case rate,932.9,713.46, 952.54 ,883.8
98110707,EAP,CPT® 24560,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24560 Treat Humerus Epicond Fracture,1,1065," 1,011.75 ",600.6," 1,011.75 ", 609.70 , 609.70 ,Current Medicare Rates,1033.05,1022.4,1011.75,1011.75,Included in ER Case rate,1011.75,600.6," 1,033.05 ",958.5
98110713,EAP,CPT® 24600,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24600 Treat Elbow Dislocation W/o Anesth,1,"1,239.00"," 1,177.05 ",693.66," 1,177.05 ", 704.17 , 704.17 ,Current Medicare Rates,1201.83,1189.44,1177.05,1177.05,Included in ER Case rate,1177.05,693.66," 1,201.83 ",1115.1
98110714,EAP,CPT® 24605,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24605 Treat Elbow Dislocation W/anesth,1,1369," 1,300.55 ",960.96," 1,300.55 ", 975.52 , 975.52 ,Current Medicare Rates,1327.93,1314.24,1300.55,1300.55,Included in ER Case rate,1300.55,960.96," 1,327.93 ",1232.1
98110716,EAP,CPT® 24640,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24640 Closed Treat Of Radial Head Subluxation W/manip,1,471, 447.45 ,157.74, 447.45 , 160.13 , 160.13 ,Current Medicare Rates,456.87,452.16,447.45,447.45,Included in ER Case rate,447.45,157.74, 456.87 ,423.9
98110718,EAP,CPT® 24650,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24650 Treat Radius Fracture,1,"1,006.00", 955.70 ,500.28, 955.70 , 507.86 , 507.86 ,Current Medicare Rates,975.82,965.76,955.7,955.7,Included in ER Case rate,955.7,500.28, 975.82 ,905.4
98110722,EAP,CPT® 24670,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 24670 Treat Ulnar Fracture,1,565.00, 536.75 ,545.16, 536.75 , 553.42 , 553.42 ,Current Medicare Rates,548.05,542.4,536.75,536.75,Included in ER Case rate,536.75,536.75, 553.42 ,508.5
98110726,EAP,CPT® 25260,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25260 Repair Forearm Tendon/muscle,1,3090," 2,935.50 ",1269.84," 2,935.50 "," 1,289.08 "," 1,289.08 ",Current Medicare Rates,2997.3,2966.4,2935.5,2935.5,Included in ER Case rate,2935.5,1269.84," 2,997.30 ",2781
98110734,EAP,CPT® 25530,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25530 Treat Fracture Of Ulna,1,994.00, 944.30 ,494.34, 944.30 , 501.83 , 501.83 ,Current Medicare Rates,964.18,954.24,944.3,944.3,Included in ER Case rate,944.3,494.34, 964.18 ,894.6
98110740,EAP,CPT® 25565,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25565 Treat Fracture Radius & Ulna W/manipulation,1,"2,011.00"," 1,910.45 ",941.82," 1,910.45 ", 956.09 , 956.09 ,Current Medicare Rates,1950.67,1930.56,1910.45,1910.45,Included in ER Case rate,1910.45,941.82," 1,950.67 ",1809.9
98110742,EAP,CPT® 25600,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25600 Treat Distal Radial Fracture Radius/una W/o Manip,1,1206," 1,145.70 ",659.34," 1,145.70 ", 669.33 , 669.33 ,Current Medicare Rates,1169.82,1157.76,1145.7,1145.7,Included in ER Case rate,1145.7,659.34," 1,169.82 ",1085.4
98110744,EAP,CPT® 25605,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25605 Treat Distal Radial Fracture Radius/ulna W/manip,1,"2,102.00"," 1,996.90 ",1031.58," 1,996.90 "," 1,047.21 "," 1,047.21 ",Current Medicare Rates,2038.94,2017.92,1996.9,1996.9,Included in ER Case rate,1996.9,1031.58," 2,038.94 ",1891.8
98110746,EAP,CPT® 25622,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25622 Treat Wrist Bone Fracture,1,995, 945.25 ,578.82, 945.25 , 587.59 , 587.59 ,Current Medicare Rates,965.15,955.2,945.25,945.25,Included in ER Case rate,945.25,578.82, 965.15 ,895.5
98110750,EAP,CPT® 25630,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25630 Treat Carpal Bone Fracture W/o Manip Each Bone,1,"1,013.00", 962.35 ,578.82, 962.35 , 587.59 , 587.59 ,Current Medicare Rates,982.61,972.48,962.35,962.35,Included in ER Case rate,962.35,578.82, 982.61 ,911.7
98110754,EAP,25650,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25650 Treat Ulnar Styloid Fracture,1,"1,256.00"," 1,193.20 ",624.36," 1,193.20 ", 633.82 , 633.82 ,Current Medicare Rates,1218.32,1205.76,1193.2,1193.2,Included in ER Case rate,1193.2,624.36," 1,218.32 ",1130.4
98110756,EAP,CPT® 25660,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 25660 Treat Wrist Dislocation W/manipulation,1,1304," 1,238.80 ",905.52," 1,238.80 ", 919.24 , 919.24 ,Current Medicare Rates,1264.88,1251.84,1238.8,1238.8,Included in ER Case rate,1238.8,905.52," 1,264.88 ",1173.6
98110761,EAP,CPT® 26010,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26010 Drainage Of Finger Abscess - Smpl,1,797.00, 757.15 ,280.5, 757.15 , 284.75 , 284.75 ,Current Medicare Rates,773.09,765.12,757.15,757.15,Included in ER Case rate,757.15,280.5, 773.09 ,717.3
98110763,EAP,CPT® 26350,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26350 Repair Finger/hand Tendon,1,1617," 1,536.15 ",1500.84," 1,536.15 "," 1,523.58 "," 1,523.58 ",Current Medicare Rates,1568.49,1552.32,1536.15,1536.15,Included in ER Case rate,1536.15,1500.84," 1,568.49 ",1455.3
98110765,EAP,CPT® 26410,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26410 Repair Extensor Tendon Hand W/ograft,1,"2,126.00"," 2,019.70 ",1211.76," 2,019.70 "," 1,230.12 "," 1,230.12 ",Current Medicare Rates,2062.22,2040.96,2019.7,2019.7,Included in ER Case rate,2019.7,1211.76," 2,062.22 ",1913.4
98110767,EAP,CPT® 26418,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26418 Repair Of Extensor Tendon Finger W/o Graft,1,"2,051.00"," 1,948.45 ",1257.3," 1,948.45 "," 1,276.35 "," 1,276.35 ",Current Medicare Rates,1989.47,1968.96,1948.45,1948.45,Included in ER Case rate,1948.45,1257.3," 1,989.47 ",1845.9
98110771,EAP,CPT® 26600,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26600 Treat Metacarpal Fracture Single W/o Manip,1,844, 801.80 ,583.44, 801.80 , 592.28 , 592.28 ,Current Medicare Rates,818.68,810.24,801.8,801.8,Included in ER Case rate,801.8,583.44, 818.68 ,759.6
98110773,EAP,CPT® 26605,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26605 Treat Metacarpal Fracture Single W/manip,1,958.00, 910.10 ,605.22, 910.10 , 614.39 , 614.39 ,Current Medicare Rates,929.26,919.68,910.1,910.1,Included in ER Case rate,910.1,605.22, 929.26 ,862.2
98110775,EAP,CPT® 26641,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26641 Treat Carpometacarpal Dislocation W/manip,1,1150," 1,092.50 ",772.86," 1,092.50 ", 784.57 , 784.57 ,Current Medicare Rates,1115.5,1104,1092.5,1092.5,Included in ER Case rate,1092.5,772.86," 1,115.50 ",1035
98110777,EAP,CPT® 26645,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26645 Tx Carpometacarpal Fracture/dislocation W/manip,1,"1,217.00"," 1,156.15 ",798.6," 1,156.15 ", 810.70 , 810.70 ,Current Medicare Rates,1180.49,1168.32,1156.15,1156.15,Included in ER Case rate,1156.15,798.6," 1,180.49 ",1095.3
98110779,EAP,CPT® 26670,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26670 Cltx Carpo/metacarpl Dislc Other Than Thmb Manj Ea W/o Anes,1,"1,014.00", 963.30 ,632.28, 963.30 , 641.86 , 641.86 ,Current Medicare Rates,983.58,973.44,963.3,963.3,Included in ER Case rate,963.3,632.28, 983.58 ,912.6
98110783,EAP,CPT® 26720,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26720 Closed Tx Phalangeal Shaft Fracture Finger Or Thumb W/o Ma,1,667.00, 633.65 ,384.78, 633.65 , 390.61 , 390.61 ,Current Medicare Rates,646.99,640.32,633.65,633.65,Included in ER Case rate,633.65,384.78, 646.99 ,600.3
98110786,EAP,CPT® 26725,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26725 Closed Tx Phalangeal Shaft Fracture Finger Or Thumb W/mani,1,948.00, 900.60 ,618.42, 900.60 , 627.79 , 627.79 ,Current Medicare Rates,919.56,910.08,900.6,900.6,Included in ER Case rate,900.6,618.42, 919.56 ,853.2
98110788,EAP,CPT® 26740,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26740 Closed Tx Articular Fracture W/o Manip,1,909, 863.55 ,448.8, 863.55 , 455.60 , 455.60 ,Current Medicare Rates,881.73,872.64,863.55,863.55,Included in ER Case rate,863.55,448.8, 881.73 ,818.1
98110790,EAP,CPT® 26742,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26742 Closed Tx Articular Fracture W/manip,1,"1,231.00"," 1,169.45 ",681.78," 1,169.45 ", 692.11 , 692.11 ,Current Medicare Rates,1194.07,1181.76,1169.45,1169.45,Included in ER Case rate,1169.45,681.78," 1,194.07 ",1107.9
98110792,EAP,CPT® 26750,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26750 Closed Tx Distal Phalangeal Fracture Finger/thumb W/o Mani,1,616.00, 585.20 ,386.76, 585.20 , 392.62 , 392.62 ,Current Medicare Rates,597.52,591.36,585.2,585.2,Included in ER Case rate,585.2,386.76, 597.52 ,554.4
98110794,EAP,CPT® 26755,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26755 Closed Tx Distal Phalangeal Fracture Finger/thumb W/manip,1,786.00, 746.70 ,559.02, 746.70 , 567.49 , 567.49 ,Current Medicare Rates,762.42,754.56,746.7,746.7,Included in ER Case rate,746.7,559.02, 762.42 ,707.4
98110798,EAP,CPT® 26770,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26770 Closed Tx Finger Dislocation W/o Anesth,1,889, 844.55 ,532.62, 844.55 , 540.69 , 540.69 ,Current Medicare Rates,862.33,853.44,844.55,844.55,Included in ER Case rate,844.55,532.62, 862.33 ,800.1
98110800,EAP,CPT® 26775,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26775 Closed Tx Finger Dislocation W/anesth,1,1020, 969.00 ,720.06, 969.00 , 730.97 , 730.97 ,Current Medicare Rates,989.4,979.2,969,969,Included in ER Case rate,969,720.06, 989.40 ,918
98110835,EAP,CPT® 26951,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 26951 Amputate Finger/thumb Single W/direct Closure,1,1385," 1,315.75 ",1407.78," 1,315.75 "," 1,429.11 "," 1,429.11 ",Current Medicare Rates,1343.45,1329.6,1315.75,1315.75,Included in ER Case rate,1315.75,1315.75," 1,429.11 ",1246.5
98110142,EAP,CPT® 27198,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27198 Closed Tx Pelvic Ring Fx W/manip,1,814, 773.30 ,623.04, 773.30 , 632.48 , 632.48 ,Current Medicare Rates,789.58,781.44,773.3,773.3,Included in ER Case rate,773.3,623.04, 789.58 ,732.6
98110851,EAP,CPT® 27252,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27252 Closed Tx Hip Dislocation W/anesth,1,3302," 3,136.90 ",1496.22," 3,136.90 "," 1,518.89 "," 1,518.89 ",Current Medicare Rates,3202.94,3169.92,3136.9,3136.9,Included in ER Case rate,3136.9,1496.22," 3,202.94 ",2971.8
98110950,EAP,CPT® 27256,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27256 Tx Hip Dislocation W/o Anesth W/o Man,1,"1,433.00"," 1,361.35 ",476.52," 1,361.35 ", 483.74 , 483.74 ,Current Medicare Rates,1390.01,1375.68,1361.35,1361.35,Included in ER Case rate,1361.35,476.52," 1,390.01 ",1289.7
98110854,EAP,CPT® 27265,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27265 Tx Post Hip Arthroplasty Dislocation W/o Anesth,1,"1,317.00"," 1,251.15 ",836.22," 1,251.15 ", 848.89 , 848.89 ,Current Medicare Rates,1277.49,1264.32,1251.15,1251.15,Included in ER Case rate,1251.15,836.22," 1,277.49 ",1185.3
98110855,EAP,CPT® 27266,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27266 Tx Post Hip Arthroplasty Dislocation W/anesth,1,1822," 1,730.90 ",1166.22," 1,730.90 "," 1,183.89 "," 1,183.89 ",Current Medicare Rates,1767.34,1749.12,1730.9,1730.9,Included in ER Case rate,1730.9,1166.22," 1,767.34 ",1639.8
98110864,EAP,CPT® 27301,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27301 Drain Thigh/knee Lesion,1,"2,587.00"," 2,457.65 ",1009.8," 2,457.65 "," 1,025.10 "," 1,025.10 ",Current Medicare Rates,2509.39,2483.52,2457.65,2457.65,Included in ER Case rate,2457.65,1009.8," 2,509.39 ",2328.3
98110878,EAP,CPT® 27550,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27550 Treat Knee Dislocation,1,1636," 1,554.20 ",951.72," 1,554.20 ", 966.14 , 966.14 ,Current Medicare Rates,1586.92,1570.56,1554.2,1554.2,Included in ER Case rate,1554.2,951.72," 1,586.92 ",1472.4
98110879,EAP,CPT® 27552,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27552 Closed Treat Knee Dislocation W/anesth,1,"1,988.00"," 1,888.60 ",1264.56," 1,888.60 "," 1,283.72 "," 1,283.72 ",Current Medicare Rates,1928.36,1908.48,1888.6,1888.6,Included in ER Case rate,1888.6,1264.56," 1,928.36 ",1789.2
98110881,EAP,CPT® 27560,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27560 Closed Treat Knee Dislocation W/o Anesth,1,"1,203.00"," 1,142.85 ",693.66," 1,142.85 ", 704.17 , 704.17 ,Current Medicare Rates,1166.91,1154.88,1142.85,1142.85,Included in ER Case rate,1142.85,693.66," 1,166.91 ",1082.7
98110882,EAP,CPT® 27562,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27562 Closed Treat Patella Dislocation W/anseth,1,"2,010.00"," 1,909.50 ",984.06," 1,909.50 ", 998.97 , 998.97 ,Current Medicare Rates,1949.7,1929.6,1909.5,1909.5,Included in ER Case rate,1909.5,984.06," 1,949.70 ",1809
98110892,EAP,CPT® 27760,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27760 Closed Tx Of Medial Malleolus Fracture W/o Manip,1,"1,197.00"," 1,137.15 ",621.06," 1,137.15 ", 630.47 , 630.47 ,Current Medicare Rates,1161.09,1149.12,1137.15,1137.15,Included in ER Case rate,1137.15,621.06," 1,161.09 ",1077.3
98110895,EAP,CPT® 27762,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27762 Closed Tx Of Medial Malleolus Fracture W/manip,1,"1,838.00"," 1,746.10 ",881.1," 1,746.10 ", 894.45 , 894.45 ,Current Medicare Rates,1782.86,1764.48,1746.1,1746.1,Included in ER Case rate,1746.1,881.1," 1,782.86 ",1654.2
98110939,EAP,CPT® 27767,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 27767 Er Closed Tx Posterior Malleous Fx, W/o",1,"1,204.00"," 1,143.80 ",588.72," 1,143.80 ", 597.64 , 597.64 ,Current Medicare Rates,1167.88,1155.84,1143.8,1143.8,Included in ER Case rate,1143.8,588.72," 1,167.88 ",1083.6
98110897,EAP,CPT® 27768,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27768 Cltx Post Ankle Fx W/manipulation,1,1204," 1,143.80 ",901.56," 1,143.80 ", 915.22 , 915.22 ,Current Medicare Rates,1167.88,1155.84,1143.8,1143.8,Included in ER Case rate,1143.8,901.56," 1,167.88 ",1083.6
98110402,EAP,CPT® 27786,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27786 Closed Treatment Of Ankle Fracture W/o Manip,1,1155," 1,097.25 ",582.78," 1,097.25 ", 591.61 , 591.61 ,Current Medicare Rates,1120.35,1108.8,1097.25,1097.25,Included in ER Case rate,1097.25,582.78," 1,120.35 ",1039.5
98110405,EAP,CPT® 27788,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27788 Closed Treatment Of Ankle Fracture W/manip,1,"1,064.00"," 1,010.80 ",778.14," 1,010.80 ", 789.93 , 789.93 ,Current Medicare Rates,1032.08,1021.44,1010.8,1010.8,Included in ER Case rate,1010.8,778.14," 1,032.08 ",957.6
98110417,EAP,CPT® 27840,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27840 Closed Treatment Of Ankle Dislocation W/o Anesth,1,910.00, 864.50 ,780.12, 864.50 , 791.94 , 791.94 ,Current Medicare Rates,882.7,873.6,864.5,864.5,Included in ER Case rate,864.5,780.12, 882.70 ,819
98110418,EAP,CPT® 27842,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 27842 Closed Treat Ankle Dislocation W/anesth,1,"1,769.00"," 1,680.55 ",982.74," 1,680.55 ", 997.63 , 997.63 ,Current Medicare Rates,1715.93,1698.24,1680.55,1680.55,Included in ER Case rate,1680.55,982.74," 1,715.93 ",1592.1
98110485,EAP,CPT® 28190,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28190 Removal Of Foot Foreign Body,1,769.00, 730.55 ,259.38, 730.55 , 263.31 , 263.31 ,Current Medicare Rates,745.93,738.24,730.55,730.55,Included in ER Case rate,730.55,259.38, 745.93 ,692.1
98110419,EAP,CPT® 28192,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28192 Removal Of Foot Foreign Body Deep,1,1196," 1,136.20 ",609.18," 1,136.20 ", 618.41 , 618.41 ,Current Medicare Rates,1160.12,1148.16,1136.2,1136.2,Included in ER Case rate,1136.2,609.18," 1,160.12 ",1076.4
98110429,EAP,CPT® 28430,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28430 Treatment Of Talus Fracture W/o Manipulation,1,649.00, 616.55 ,424.38, 616.55 , 430.81 , 430.81 ,Current Medicare Rates,629.53,623.04,616.55,616.55,Included in ER Case rate,616.55,424.38, 629.53 ,584.1
98110436,EAP,CPT® 28470,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28470 Treat Metatarsal Fracture W/o Manipulation,1,869, 825.55 ,411.18, 825.55 , 417.41 , 417.41 ,Current Medicare Rates,842.93,834.24,825.55,825.55,Included in ER Case rate,825.55,411.18, 842.93 ,782.1
98110440,EAP,CPT® 28490,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28490 Closed Treat Big Toe Fracture W/o Manip,1,438, 416.10 ,250.8, 416.10 , 254.60 , 254.60 ,Current Medicare Rates,424.86,420.48,416.1,416.1,Included in ER Case rate,416.1,250.8, 424.86 ,394.2
98110443,EAP,CPT® 28495,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28495 Treat Big Toe Fracture W/manipulation,1,407.00, 386.65 ,297, 386.65 , 301.50 , 301.50 ,Current Medicare Rates,394.79,390.72,386.65,386.65,Included in ER Case rate,386.65,297, 394.79 ,366.3
98110445,EAP,CPT® 28510,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28510 Treatment Of Toe Fracture Phalanx,1,473.00, 449.35 ,240.9, 449.35 , 244.55 , 244.55 ,Current Medicare Rates,458.81,454.08,449.35,449.35,Included in ER Case rate,449.35,240.9, 458.81 ,425.7
98110448,EAP,CPT® 28515,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28515 Treatment Of Toe Fracture Phalanx W/manip,1,507.00, 481.65 ,286.44, 481.65 , 290.78 , 290.78 ,Current Medicare Rates,491.79,486.72,481.65,481.65,Included in ER Case rate,481.65,286.44, 491.79 ,456.3
98110460,EAP,CPT® 28630,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28630 Treat Metatarsophal Dislocation,1,501, 475.95 ,219.12, 475.95 , 222.44 , 222.44 ,Current Medicare Rates,485.97,480.96,475.95,475.95,Included in ER Case rate,475.95,219.12, 485.97 ,450.9
98110941,EAP,CPT® 28635,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28635 Treat Toe Dislocation W/manipulation W/anesth,1,465, 441.75 ,265.32, 441.75 , 269.34 , 269.34 ,Current Medicare Rates,451.05,446.4,441.75,441.75,Included in ER Case rate,441.75,265.32, 451.05 ,418.5
98110462,EAP,CPT® 28660,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 28660 Closed Treat Toe Dislocation,1,450, 427.50 ,184.8, 427.50 , 187.60 , 187.60 ,Current Medicare Rates,436.5,432,427.5,427.5,Included in ER Case rate,427.5,184.8, 436.50 ,405
98110466,EAP,CPT® 29065,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29065 Long Arm Cast Application,1,289, 274.55 ,134.64, 274.55 , 136.68 , 136.68 ,Current Medicare Rates,280.33,277.44,274.55,274.55,Included in ER Case rate,274.55,134.64, 280.33 ,260.1
98110467,EAP,CPT® 29075,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29075 Short Arm Cast Application,1,259, 246.05 ,124.08, 246.05 , 125.96 , 125.96 ,Current Medicare Rates,251.23,248.64,246.05,246.05,Included in ER Case rate,246.05,124.08, 251.23 ,233.1
98110468,EAP,CPT® 29105,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29105 Long Arm Splint Application,1,222, 210.90 ,83.16, 210.90 , 84.42 , 84.42 ,Current Medicare Rates,215.34,213.12,210.9,210.9,Included in ER Case rate,210.9,83.16, 215.34 ,199.8
98110469,EAP,CPT® 29125,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29125 Short Arm Splint Application,1,193.00, 183.35 ,79.86, 183.35 , 81.07 , 81.07 ,Current Medicare Rates,187.21,185.28,183.35,183.35,Included in ER Case rate,183.35,79.86, 187.21 ,173.7
98110470,EAP,CPT® 29126,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29126 Apply Forearm Splint Dyn,1,190.00, 180.50 ,97.02, 180.50 , 98.49 , 98.49 ,Current Medicare Rates,184.3,182.4,180.5,180.5,Included in ER Case rate,180.5,97.02, 184.30 ,171
98110906,EAP,CPT® 29130,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29130 Aplication Of Finger Splint Static,1,139.00, 132.05 ,58.08, 132.05 , 58.96 , 58.96 ,Current Medicare Rates,134.83,133.44,132.05,132.05,Included in ER Case rate,132.05,58.08, 134.83 ,125.1
98110472,EAP,CPT® 29240,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29240 Strapping Shoulder,1,174.00, 165.30 ,35.64, 165.30 , 36.18 , 36.18 ,Current Medicare Rates,168.78,167.04,165.3,165.3,Included in ER Case rate,165.3,35.64, 168.78 ,156.6
98110486,EAP,CPT® 29345,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29345 Application/long Leg Cast,1,390.00, 370.50 ,196.02, 370.50 , 198.99 , 198.99 ,Current Medicare Rates,378.3,374.4,370.5,370.5,Included in ER Case rate,370.5,196.02, 378.30 ,351
98110476,EAP,CPT® 29405,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29405 Short Leg Cast Application,1,439, 417.05 ,114.84, 417.05 , 116.58 , 116.58 ,Current Medicare Rates,425.83,421.44,417.05,417.05,Included in ER Case rate,417.05,114.84, 425.83 ,395.1
98110477,EAP,CPT® 29425,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29425 Apply Short Walking Leg Cast,1,476, 452.20 ,106.26, 452.20 , 107.87 , 107.87 ,Current Medicare Rates,461.72,456.96,452.2,452.2,Included in ER Case rate,452.2,106.26, 461.72 ,428.4
98110479,EAP,CPT® 29505,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29505 Application Long Leg Splint,1,324, 307.80 ,102.3, 307.80 , 103.85 , 103.85 ,Current Medicare Rates,314.28,311.04,307.8,307.8,Included in ER Case rate,307.8,102.3, 314.28 ,291.6
98110480,EAP,CPT® 29515,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29515 Short Leg Splint Application,1,293.00, 278.35 ,97.02, 278.35 , 98.49 , 98.49 ,Current Medicare Rates,284.21,281.28,278.35,278.35,Included in ER Case rate,278.35,97.02, 284.21 ,263.7
98110625,EAP,CPT® 29550,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29550 Strapping Of Toes,1,103.00, 97.85 ,21.78, 97.85 , 22.11 , 22.11 ,Current Medicare Rates,99.91,98.88,97.85,97.85,Included in ER Case rate,97.85,21.78, 99.91 ,92.7
98110482,EAP,CPT® 29580,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29580 Application Of Unaboot,1,130, 123.50 ,51.48, 123.50 , 52.26 , 52.26 ,Current Medicare Rates,126.1,124.8,123.5,123.5,Included in ER Case rate,123.5,51.48, 126.10 ,117
98110430,EAP,CPT® 29700,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29700 Remov Bival Gaun Boot/body Cast,1,168, 159.60 ,64.68, 159.60 , 65.66 , 65.66 ,Current Medicare Rates,162.96,161.28,159.6,159.6,Included in ER Case rate,159.6,64.68, 162.96 ,151.2
98110483,EAP,CPT® 29705,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 29705 Remove Or Bivalve Cast-arm Or Leg,1,213, 202.35 ,87.78, 202.35 , 89.11 , 89.11 ,Current Medicare Rates,206.61,204.48,202.35,202.35,Included in ER Case rate,202.35,87.78, 206.61 ,191.7
98110316,EAP,CPT® 30300,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 30300 Remove Nasal Foreign Body,1,476.7, 452.87 ,247.5, 452.87 , 251.25 , 251.25 ,Current Medicare Rates,462.4,457.63,452.87,452.87,Included in ER Case rate,452.87,247.5, 462.40 ,429.03
98110317,EAP,CPT® 30901,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 30901 Control Of Nosebleed Simple,1,348.00, 330.60 ,111.54, 330.60 , 113.23 , 113.23 ,Current Medicare Rates,337.56,334.08,330.6,330.6,Included in ER Case rate,330.6,111.54, 337.56 ,313.2
98110319,EAP,CPT® 30903,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 30903 Control Of Nosebleed Complex,1,635.00, 603.25 ,152.46, 603.25 , 154.77 , 154.77 ,Current Medicare Rates,615.95,609.6,603.25,603.25,Included in ER Case rate,603.25,152.46, 615.95 ,571.5
98110321,EAP,CPT® 30905,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 30905 Control Of Nosebleed Posterior,1,837.00, 795.15 ,208.56, 795.15 , 211.72 , 211.72 ,Current Medicare Rates,811.89,803.52,795.15,795.15,Included in ER Case rate,795.15,208.56, 811.89 ,753.3
98110322,EAP,CPT® 30906,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 30906 Repeat Control Of Nosebleed,1,749.00, 711.55 ,262.02, 711.55 , 265.99 , 265.99 ,Current Medicare Rates,726.53,719.04,711.55,711.55,Included in ER Case rate,711.55,262.02, 726.53 ,674.1
98110324,EAP,CPT® 31500,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 31500 Ins Emergency Airway,1,290, 275.50 ,275.22, 275.50 , 279.39 , 279.39 ,Current Medicare Rates,281.3,278.4,275.5,275.5,Included in ER Case rate,275.5,275.22, 281.30 ,261
98110326,EAP,CPT® 31505,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 31505 Diagnostic Laryngoscopy Indirect,1,257, 244.15 ,97.02, 244.15 , 98.49 , 98.49 ,Current Medicare Rates,249.29,246.72,244.15,244.15,Included in ER Case rate,244.15,97.02, 249.29 ,231.3
98110328,EAP,CPT® 31511,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 31511 Remove Foreign Body Larynx,1,738.00, 701.10 ,263.34, 701.10 , 267.33 , 267.33 ,Current Medicare Rates,715.86,708.48,701.1,701.1,Included in ER Case rate,701.1,263.34, 715.86 ,664.2
98110336,EAP,CPT® 31605,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 31605 Cricothyroidotomy,1,"2,034.00"," 1,932.30 ",650.1," 1,932.30 ", 659.95 , 659.95 ,Current Medicare Rates,1972.98,1952.64,1932.3,1932.3,Included in ER Case rate,1932.3,650.1," 1,972.98 ",1830.6
98110342,EAP,CPT® 32551,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 32551 Insertion Of Chest Tube,1,924.00, 877.80 ,302.28, 877.80 , 306.86 , 306.86 ,Current Medicare Rates,896.28,887.04,877.8,877.8,Included in ER Case rate,877.8,302.28, 896.28 ,831.6
98110931,EAP,CPT® 32554,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 32554 Thoracentesis/aspir W/o Img Gd,1,558.00, 530.10 ,171.6, 530.10 , 174.20 , 174.20 ,Current Medicare Rates,541.26,535.68,530.1,530.1,Included in ER Case rate,530.1,171.6, 541.26 ,502.2
98110930,EAP,CPT® 32555,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 32555 Thoracentesis/aspir W Img Gd,1,"1,008.00", 957.60 ,211.86, 957.60 , 215.07 , 215.07 ,Current Medicare Rates,977.76,967.68,957.6,957.6,Included in ER Case rate,957.6,211.86, 977.76 ,907.2
98110348,EAP,CPT® 36000,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 36000 Place Needle In Vein,1,216.00, 205.20 ,17.82, 205.20 , 18.09 , 18.09 ,Current Medicare Rates,209.52,207.36,205.2,205.2,Included in ER Case rate,205.2,17.82, 209.52 ,194.4
98110587,EAP,CPT® 36600,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 36600 Withdrawal Of Arterial Blood,1,9.00, 8.55 ,29.04, 8.55 , 29.48 , 29.48 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 29.48 ,8.1
98110226,EAP,CPT® 36680,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 36680 Insert Needle Bone Cavity,1,340.00, 323.00 ,116.16, 323.00 , 117.92 , 117.92 ,Current Medicare Rates,329.8,326.4,323,323,Included in ER Case rate,323,116.16, 329.80 ,306
98110609,EAP,CPT® 37609,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 37609 Temporal Artery Procedure,1,840.00, 798.00 ,402.6, 798.00 , 408.70 , 408.70 ,Current Medicare Rates,814.8,806.4,798,798,Included in ER Case rate,798,402.6, 814.80 ,756
98110351,EAP,CPT® 40654,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 40654 Repair Lip, Full Thickness Over One-half Vertical Height,",1,689, 654.55 ,843.48, 654.55 , 856.26 , 856.26 ,Current Medicare Rates,668.33,661.44,654.55,654.55,Included in ER Case rate,654.55,654.55, 856.26 ,620.1
98110354,EAP,CPT® 40830,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 40830 Repair Mouth Laceration <2.5cm,1,487, 462.65 ,287.76, 462.65 , 292.12 , 292.12 ,Current Medicare Rates,472.39,467.52,462.65,462.65,Included in ER Case rate,462.65,287.76, 472.39 ,438.3
98110357,EAP,CPT® 41250,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 41250 Repair Tongue Laceration <2.6cm, Floor Of Mouth And/or Ant",1,585.00, 555.75 ,304.26, 555.75 , 308.87 , 308.87 ,Current Medicare Rates,567.45,561.6,555.75,555.75,Included in ER Case rate,555.75,304.26, 567.45 ,526.5
98110359,EAP,CPT® 41252,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"Hc Pr 41252 Repair Of Laceration Of Tongue, Floor Of Mouth, Over 2.6 C",1,1185," 1,125.75 ",414.48," 1,125.75 ", 420.76 , 420.76 ,Current Medicare Rates,1149.45,1137.6,1125.75,1125.75,Included in ER Case rate,1125.75,414.48," 1,149.45 ",1066.5
98110360,EAP,CPT® 41800,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 41800 Drainage Of Gum Lesion,1,279.00, 265.05 ,304.92, 265.05 , 309.54 , 309.54 ,Current Medicare Rates,270.63,267.84,265.05,265.05,Included in ER Case rate,265.05,265.05, 309.54 ,251.1
98110366,EAP,CPT® 42700,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 42700 Drainage Of Tonsil Abscess,1,456, 433.20 ,269.94, 433.20 , 274.03 , 274.03 ,Current Medicare Rates,442.32,437.76,433.2,433.2,Included in ER Case rate,433.2,269.94, 442.32 ,410.4
98110368,EAP,CPT® 42809,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 42809 Remove Pharynx Foreign Body,1,588, 558.60 ,250.14, 558.60 , 253.93 , 253.93 ,Current Medicare Rates,570.36,564.48,558.6,558.6,Included in ER Case rate,558.6,250.14, 570.36 ,529.2
98110377,EAP,CPT® 45005,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 45005 Drainage Of Rectal Abscess,1,688, 653.60 ,330.66, 653.60 , 335.67 , 335.67 ,Current Medicare Rates,667.36,660.48,653.6,653.6,Included in ER Case rate,653.6,330.66, 667.36 ,619.2
98110380,EAP,CPT® 45915,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 45915 Remove Rectal Obstruction,1,828, 786.60 ,452.76, 786.60 , 459.62 , 459.62 ,Current Medicare Rates,803.16,794.88,786.6,786.6,Included in ER Case rate,786.6,452.76, 803.16 ,745.2
98110381,EAP,CPT® 46040,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 46040 Incision Of Rectal Abscess,1,"1,443.00"," 1,370.85 ",843.48," 1,370.85 ", 856.26 , 856.26 ,Current Medicare Rates,1399.71,1385.28,1370.85,1370.85,Included in ER Case rate,1370.85,843.48," 1,399.71 ",1298.7
98110382,EAP,CPT® 46050,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 46050 Incision Of Anal Abscess,1,542.00, 514.90 ,200.64, 514.90 , 203.68 , 203.68 ,Current Medicare Rates,525.74,520.32,514.9,514.9,Included in ER Case rate,514.9,200.64, 525.74 ,487.8
98110383,EAP,CPT® 46083,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 46083 Incise External Hemorrhoid,1,513.00, 487.35 ,217.14, 487.35 , 220.43 , 220.43 ,Current Medicare Rates,497.61,492.48,487.35,487.35,Included in ER Case rate,487.35,217.14, 497.61 ,461.7
98110384,EAP,CPT® 46221,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 46221 Ligation Of Hemorrhoid(s),1,758.00, 720.10 ,380.82, 720.10 , 386.59 , 386.59 ,Current Medicare Rates,735.26,727.68,720.1,720.1,Included in ER Case rate,720.1,380.82, 735.26 ,682.2
98110385,EAP,CPT® 46230,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 46230 Removal Of Anal Tags,1,825, 783.75 ,341.88, 783.75 , 347.06 , 347.06 ,Current Medicare Rates,800.25,792,783.75,783.75,Included in ER Case rate,783.75,341.88, 800.25 ,742.5
98110386,EAP,CPT® 46320,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 46320 Removal Of Hemorrhoid Clot,1,474.00, 450.30 ,223.08, 450.30 , 226.46 , 226.46 ,Current Medicare Rates,459.78,455.04,450.3,450.3,Included in ER Case rate,450.3,223.08, 459.78 ,426.6
98110387,EAP,CPT® 46600,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 46600 Diagnostic Anoscopy,1,239.00, 227.05 ,81.18, 227.05 , 82.41 , 82.41 ,Current Medicare Rates,231.83,229.44,227.05,227.05,Included in ER Case rate,227.05,81.18, 231.83 ,215.1
98110907,EAP,CPT® 49082,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 49082 Abd Paracent W/o Imag Guid,1,591.00, 561.45 ,142.56, 561.45 , 144.72 , 144.72 ,Current Medicare Rates,573.27,567.36,561.45,561.45,Included in ER Case rate,561.45,142.56, 573.27 ,531.9
98110908,EAP,CPT® 49083,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 49083 Abd Paracent W/imag Guidance,1,865, 821.75 ,205.92, 821.75 , 209.04 , 209.04 ,Current Medicare Rates,839.05,830.4,821.75,821.75,Included in ER Case rate,821.75,205.92, 839.05 ,778.5
98110396,EAP,CPT® 51702,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 51702 Insert Temp Bladder Catheter,1,218.00, 207.10 ,48.84, 207.10 , 49.58 , 49.58 ,Current Medicare Rates,211.46,209.28,207.1,207.1,Included in ER Case rate,207.1,48.84, 211.46 ,196.2
98110808,EAP,CPT® 58301,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 58301 Remove Intrauterine Device,1,280.00, 266.00 ,130.02, 266.00 , 131.99 , 131.99 ,Current Medicare Rates,271.6,268.8,266,266,Included in ER Case rate,266,130.02, 271.60 ,252
98110602,EAP,CPT® 59409,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 59409 Vaginal Delivery,1,2277," 2,163.15 ",1581.36," 2,163.15 "," 1,605.32 "," 1,605.32 ",Current Medicare Rates,2208.69,2185.92,2163.15,2163.15,Included in ER Case rate,2163.15,1581.36," 2,208.69 ",2049.3
98110812,EAP,CPT® 62270,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 62270 Spinal Fluid Tap Diagnostic,1,516, 490.20 ,122.76, 490.20 , 124.62 , 124.62 ,Current Medicare Rates,500.52,495.36,490.2,490.2,Included in ER Case rate,490.2,122.76, 500.52 ,464.4
98110813,EAP,CPT® 62272,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 62272 Drain Cerebro Spinal Fluid,1,9.00, 8.55 ,178.2, 8.55 , 180.90 , 180.90 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 180.90 ,8.1
98110814,EAP,CPT® 64400,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 64400 Nerve Block Inj Trigeminal,1,180.00, 171.00 ,99, 171.00 , 100.50 , 100.50 ,Current Medicare Rates,174.6,172.8,171,171,Included in ER Case rate,171,99, 174.60 ,162
98110034,EAP,CPT® 64999,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 64999 Nerve Block Inj Facial Cdm,1,347, 329.65 ,0, 329.65 , -   , -   ,Current Medicare Rates,336.59,333.12,329.65,329.65,Included in ER Case rate,329.65,0, 336.59 ,312.3
98110818,EAP,CPT® 65205,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 65205 Remove Foreign Body From Eye Superficial,1,166, 157.70 ,56.76, 157.70 , 57.62 , 57.62 ,Current Medicare Rates,161.02,159.36,157.7,157.7,Included in ER Case rate,157.7,56.76, 161.02 ,149.4
98110819,EAP,CPT® 65210,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 65210 Remove Foreign Body From Eye Embedded,1,345.00, 327.75 ,69.96, 327.75 , 71.02 , 71.02 ,Current Medicare Rates,334.65,331.2,327.75,327.75,Included in ER Case rate,327.75,69.96, 334.65 ,310.5
98110820,EAP,CPT® 65220,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 65220 Remove Foreign Body From Eye Corneal W/o Slit Lamp,1,292, 277.40 ,81.18, 277.40 , 82.41 , 82.41 ,Current Medicare Rates,283.24,280.32,277.4,277.4,Included in ER Case rate,277.4,81.18, 283.24 ,262.8
98110821,EAP,CPT® 65222,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 65222 Remove Foreign Body From Eye Corneal W/ Slit Lamp,1,327, 310.65 ,97.02, 310.65 , 98.49 , 98.49 ,Current Medicare Rates,317.19,313.92,310.65,310.65,Included in ER Case rate,310.65,97.02, 317.19 ,294.3
98110949,EAP,CPT® 65270,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 65270 Repair Of Eye Wound,1,780, 741.00 ,275.22, 741.00 , 279.39 , 279.39 ,Current Medicare Rates,756.6,748.8,741,741,Included in ER Case rate,741,275.22, 756.60 ,702
98110826,EAP,CPT® 67938,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 67938 Remove Eyelid Foreign Body,1,881.00, 836.95 ,230.34, 836.95 , 233.83 , 233.83 ,Current Medicare Rates,854.57,845.76,836.95,836.95,Included in ER Case rate,836.95,230.34, 854.57 ,792.9
98110830,EAP,CPT® 69200,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 69200 Clear Outer Ear Canal W/o General Anesthesia,1,256, 243.20 ,93.06, 243.20 , 94.47 , 94.47 ,Current Medicare Rates,248.32,245.76,243.2,243.2,Included in ER Case rate,243.2,93.06, 248.32 ,230.4
98110645,EAP,CPT® 69209,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 69209 Remove Impacted Ear Wax Uni,1,45, 42.75 ,30.36, 42.75 , 30.82 , 30.82 ,Current Medicare Rates,43.65,43.2,42.75,42.75,Included in ER Case rate,42.75,30.36, 43.65 ,40.5
98110831,EAP,CPT® 69210,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 69210 Remove Impacted Ear Wax,1,146, 138.70 ,64.02, 138.70 , 64.99 , 64.99 ,Current Medicare Rates,141.62,140.16,138.7,138.7,Included in ER Case rate,138.7,64.02, 141.62 ,131.4
98110596,EAP,CPT® 92950,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 92950 Cardiopulmonary Resuscitation,1,1106," 1,050.70 ",355.08," 1,050.70 ", 360.46 , 360.46 ,Current Medicare Rates,1072.82,1061.76,1050.7,1050.7,Included in ER Case rate,1050.7,355.08," 1,072.82 ",995.4
98110102,EAP,CPT® 92960,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 92960 Cardioversion Elective External,1,560, 532.00 ,210.54, 532.00 , 213.73 , 213.73 ,Current Medicare Rates,543.2,537.6,532,532,Included in ER Case rate,532,210.54, 543.20 ,504
98110605,EAP,CPT® 93005,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 93005 Ecg 12 Lead Tracing Only,1,20, 19.00 ,12.54, 19.00 , 12.73 , 12.73 ,Current Medicare Rates,19.4,19.2,19,19,Included in ER Case rate,19,12.54, 19.40 ,18
98110144,EAP,CPT® 99151,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99151 Mod Sed Same Phys/qhp <5yrs 1st 15 Min,1,424, 402.80 ,47.52, 402.80 , 48.24 , 48.24 ,Current Medicare Rates,411.28,407.04,402.8,402.8,Included in ER Case rate,402.8,47.52, 411.28 ,381.6
98110145,EAP,CPT® 99152,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99152 Mod Sed Same Phys/qhp 5/>yrs 1st 15 Min,1,424, 402.80 ,24.42, 402.80 , 24.79 , 24.79 ,Current Medicare Rates,411.28,407.04,402.8,402.8,Included in ER Case rate,402.8,24.42, 411.28 ,381.6
98110146,EAP,CPT® 99153,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99153 Mod Sed Same Phys/qhp Ea Addl 15 Min,1,232, 220.40 ,21.78, 220.40 , 22.11 , 22.11 ,Current Medicare Rates,225.04,222.72,220.4,220.4,Included in ER Case rate,220.4,21.78, 225.04 ,208.8
98110147,EAP,CPT® 99155,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99155 Mod Sed Oth Phys/qhp <5 Yrs 1st 15 Min,1,424, 402.80 ,161.04, 402.80 , 163.48 , 163.48 ,Current Medicare Rates,411.28,407.04,402.8,402.8,Included in ER Case rate,402.8,161.04, 411.28 ,381.6
98110149,EAP,CPT® 99156,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99156 Mod Sed Oth Phys/qhp 5/>yrs 1st 15 Min,1,424, 402.80 ,147.84, 402.80 , 150.08 , 150.08 ,Current Medicare Rates,411.28,407.04,402.8,402.8,Included in ER Case rate,402.8,147.84, 411.28 ,381.6
98110148,EAP,CPT® 99157,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99157 Mod Sed Other Phys/qhp Ea Addl 15 Min,1,232, 220.40 ,120.78, 220.40 , 122.61 , 122.61 ,Current Medicare Rates,225.04,222.72,220.4,220.4,Included in ER Case rate,220.4,120.78, 225.04 ,208.8
98110902,EAP,CPT® 99175,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99175 Induction Of Vomiting,1,172, 163.40 ,59.4, 163.40 , 60.30 , 60.30 ,Current Medicare Rates,166.84,165.12,163.4,163.4,Included in ER Case rate,163.4,59.4, 166.84 ,154.8
98110604,EAP,CPT® 99281,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99281 Emergency Dept Visit Level I,1,177, 168.15 ,23.1, 168.15 , 23.45 , 23.45 ,Current Medicare Rates,171.69,169.92,168.15,168.15,Included in ER Case rate,168.15,23.1, 171.69 ,159.3
98110489,EAP,CPT® 99282,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99282 Emergency Dept Visit Level Ii,1,243, 230.85 ,81.84, 230.85 , 83.08 , 83.08 ,Current Medicare Rates,235.71,233.28,230.85,230.85,Included in ER Case rate,230.85,81.84, 235.71 ,218.7
98110009,EAP,CPT® 99283,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99283 Emergency Dept Visit Level Iii,1,535, 508.25 ,140.58, 508.25 , 142.71 , 142.71 ,Current Medicare Rates,518.95,513.6,508.25,508.25,Included in ER Case rate,508.25,140.58, 518.95 ,481.5
98110012,EAP,CPT® 99284,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99284 Emergency Dept Visit Level Iv,1,829, 787.55 ,236.28, 787.55 , 239.86 , 239.86 ,Current Medicare Rates,804.13,795.84,787.55,787.55,Included in ER Case rate,787.55,236.28, 804.13 ,746.1
98110016,EAP,CPT® 99285,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99285 Emergency Dept Visit Level 5,1,1460," 1,387.00 ",343.86," 1,387.00 ", 349.07 , 349.07 ,Current Medicare Rates,1416.2,1401.6,1387,1387,Included in ER Case rate,1387,343.86," 1,416.20 ",1314
98110021,EAP,CPT® 99291,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99291 Critical Care First Hour,1,804, 763.80 ,416.46, 763.80 , 422.77 , 422.77 ,Current Medicare Rates,779.88,771.84,763.8,763.8,Included in ER Case rate,763.8,416.46, 779.88 ,723.6
98110023,EAP,CPT® 99292,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99292 Critical Care Addl 30 Min,1,332, 315.40 ,209.22, 315.40 , 212.39 , 212.39 ,Current Medicare Rates,322.04,318.72,315.4,315.4,Included in ER Case rate,315.4,209.22, 322.04 ,298.8
98110003,EAP,CPT® 99408,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99408 Alcohol/drug Screen 15-30 Min,1,86, 81.70 ,62.04, 81.70 , 62.98 , 62.98 ,Current Medicare Rates,83.42,82.56,81.7,81.7,Included in ER Case rate,81.7,62.04, 83.42 ,77.4
98110005,EAP,CPT® 99409,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,Hc Pr 99409 Alcohol/drug Screen > 30 Min,1,169, 160.55 ,124.08, 160.55 , 125.96 , 125.96 ,Current Medicare Rates,163.93,162.24,160.55,160.55,Included in ER Case rate,160.55,124.08, 163.93 ,152.1
98110584,EAP,CPT® 24200,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,REMOVAL OF ARM FOREIGN BODY,1,551, 523.45 ,276.54, 523.45 , 280.73 , 280.73 ,Current Medicare Rates,534.47,528.96,523.45,523.45,Included in ER Case rate,523.45,276.54, 534.47 ,495.9
98110349,EAP,CPT® 40650,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,"REPAIR LIP, FULL THICKNESS VERMILION ONLY",1,662, 628.90 ,623.7, 628.90 , 633.15 , 633.15 ,Current Medicare Rates,642.14,635.52,628.9,628.9,Included in ER Case rate,628.9,623.7, 642.14 ,595.8
97510016,EAP,CPT® 97597,,0981 - PROFESSIONAL FEES - EMERGENCY ROOM,RMVL DEVITAL TIS 20 CM/<,1,210, 199.50 ,69.3, 199.50 , 70.35 , 70.35 ,Current Medicare Rates,203.7,201.6,199.5,199.5,Included in ER Case rate,199.5,69.3, 203.70 ,189
96910493,EAP,11450,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 11450 REMOVAL SWEAT GLAND LESION AXIL,1,926, 879.70 ,518.1, 879.70 , 525.95 , 525.95 ,Current Medicare Rates,898.22,888.96,879.7,879.7,Included in ER Case rate,879.7,518.1, 898.22 ,833.4
96910493,EAP,11450,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 11450 REMOVAL SWEAT GLAND LESION AXIL,1,926, 879.70 ,518.1, 879.70 , 525.95 , 525.95 ,Current Medicare Rates,898.22,888.96,879.7,879.7,Included in ER Case rate,879.7,518.1, 898.22 ,833.4
96910493,EAP,11450,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 11450 REMOVAL SWEAT GLAND LESION AXIL,1,926, 879.70 ,518.1, 879.70 , 525.95 , 525.95 ,Current Medicare Rates,898.22,888.96,879.7,879.7,Included in ER Case rate,879.7,518.1, 898.22 ,833.4
96910493,EAP,11450,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 11450 REMOVAL SWEAT GLAND LESION AXIL,1,926, 879.70 ,518.1, 879.70 , 525.95 , 525.95 ,Current Medicare Rates,898.22,888.96,879.7,879.7,Included in ER Case rate,879.7,518.1, 898.22 ,833.4
96910493,EAP,11450,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 11450 REMOVAL SWEAT GLAND LESION AXIL,1,926, 879.70 ,518.1, 879.70 , 525.95 , 525.95 ,Current Medicare Rates,898.22,888.96,879.7,879.7,Included in ER Case rate,879.7,518.1, 898.22 ,833.4
96910597,EAP,19285,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 19285 PERQ DEV LOC BREAST 1ST US IMAG,1,935, 888.25 ,165, 888.25 , 167.50 , 167.50 ,Current Medicare Rates,906.95,897.6,888.25,888.25,Included in ER Case rate,888.25,165, 906.95 ,841.5
96911040,EAP,20604,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 20604 DRAIN/INJ JOINT/BURSA SMALL W/US,1,192, 182.40 ,89.76, 182.40 , 91.12 , 91.12 ,Current Medicare Rates,186.24,184.32,182.4,182.4,Included in ER Case rate,182.4,89.76, 186.24 ,172.8
96911041,EAP,20606,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 20606 DRAIN/INJ JOINT/BURSA INTERMEDIATE W/US,1,219, 208.05 ,101.64, 208.05 , 103.18 , 103.18 ,Current Medicare Rates,212.43,210.24,208.05,208.05,Included in ER Case rate,208.05,101.64, 212.43 ,197.1
96910538,EAP,20680,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 20680 REMOVAL OF IMPLANT,1,1397," 1,327.15 ",828.96," 1,327.15 ", 841.52 , 841.52 ,Current Medicare Rates,1355.09,1341.12,1327.15,1327.15,Included in ER Case rate,1327.15,828.96," 1,355.09 ",1257.3
96910357,EAP,26111,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 26111 EXC TUM HAND/FGR >1.5 CM,1,906, 860.70 ,828.96, 860.70 , 841.52 , 841.52 ,Current Medicare Rates,878.82,869.76,860.7,860.7,Included in ER Case rate,860.7,828.96, 878.82 ,815.4
96910357,EAP,26111,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 26111 EXC TUM HAND/FGR >1.5 CM,1,906, 860.70 ,828.96, 860.70 , 841.52 , 841.52 ,Current Medicare Rates,878.82,869.76,860.7,860.7,Included in ER Case rate,860.7,828.96, 878.82 ,815.4
96910357,EAP,26111,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 26111 EXC TUM HAND/FGR >1.5 CM,1,906, 860.70 ,828.96, 860.70 , 841.52 , 841.52 ,Current Medicare Rates,878.82,869.76,860.7,860.7,Included in ER Case rate,860.7,828.96, 878.82 ,815.4
96910357,EAP,26111,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 26111 EXC TUM HAND/FGR >1.5 CM,1,906, 860.70 ,828.96, 860.70 , 841.52 , 841.52 ,Current Medicare Rates,878.82,869.76,860.7,860.7,Included in ER Case rate,860.7,828.96, 878.82 ,815.4
96910357,EAP,26111,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 26111 EXC TUM HAND/FGR >1.5 CM,1,906, 860.70 ,828.96, 860.70 , 841.52 , 841.52 ,Current Medicare Rates,878.82,869.76,860.7,860.7,Included in ER Case rate,860.7,828.96, 878.82 ,815.4
96910918,EAP,29325,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 29325 APPLICATION OF HIP CASTS,1,645, 612.75 ,348.48, 612.75 , 353.76 , 353.76 ,Current Medicare Rates,625.65,619.2,612.75,612.75,Included in ER Case rate,612.75,348.48, 625.65 ,580.5
96910873,EAP,29440,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 29440 ADDITION OF WALKER TO CAST,1,109, 103.55 ,54.12, 103.55 , 54.94 , 54.94 ,Current Medicare Rates,105.73,104.64,103.55,103.55,Included in ER Case rate,103.55,54.12, 105.73 ,98.1
96910895,EAP,29450,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 29450 APPLICATION OF LEG CAST,1,344, 326.80 ,221.1, 326.80 , 224.45 , 224.45 ,Current Medicare Rates,333.68,330.24,326.8,326.8,Included in ER Case rate,326.8,221.1, 333.68 ,309.6
98300147,EAP,29540,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 29540 STRAPPING ANKLE &/FOOT CDM,1,75, 71.25 ,34.32, 71.25 , 34.84 , 34.84 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,34.32, 72.75 ,67.5
98310172,EAP,41010,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 41010 INCISION OF TONGUE FOLD (AKA 41010),1,475, 451.25 ,219.12, 451.25 , 222.44 , 222.44 ,Current Medicare Rates,460.75,456,451.25,451.25,Included in ER Case rate,451.25,219.12, 460.75 ,427.5
98300111,EAP,64612,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64612 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL CDM,1,261, 247.95 ,233.64, 247.95 , 237.18 , 237.18 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,233.64, 253.17 ,234.9
98300111,EAP,64612,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64612 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL CDM,1,261, 247.95 ,233.64, 247.95 , 237.18 , 237.18 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,233.64, 253.17 ,234.9
98300111,EAP,64612,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64612 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL CDM,1,261, 247.95 ,233.64, 247.95 , 237.18 , 237.18 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,233.64, 253.17 ,234.9
98300111,EAP,64612,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64612 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL CDM,1,261, 247.95 ,233.64, 247.95 , 237.18 , 237.18 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,233.64, 253.17 ,234.9
98300111,EAP,64612,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64612 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL CDM,1,261, 247.95 ,233.64, 247.95 , 237.18 , 237.18 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,233.64, 253.17 ,234.9
98300112,EAP,64615,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE CDM,1,261, 247.95 ,242.88, 247.95 , 246.56 , 246.56 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,242.88, 253.17 ,234.9
98300112,EAP,64615,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE CDM,1,261, 247.95 ,242.88, 247.95 , 246.56 , 246.56 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,242.88, 253.17 ,234.9
98300112,EAP,64615,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE CDM,1,261, 247.95 ,242.88, 247.95 , 246.56 , 246.56 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,242.88, 253.17 ,234.9
98300112,EAP,64615,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE CDM,1,261, 247.95 ,242.88, 247.95 , 246.56 , 246.56 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,242.88, 253.17 ,234.9
98300112,EAP,64615,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64615 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE CDM,1,261, 247.95 ,242.88, 247.95 , 246.56 , 246.56 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,242.88, 253.17 ,234.9
98300113,EAP,64616,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64616 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA CDM,1,261, 247.95 ,214.5, 247.95 , 217.75 , 217.75 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,214.5, 253.17 ,234.9
98300113,EAP,64616,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64616 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA CDM,1,261, 247.95 ,214.5, 247.95 , 217.75 , 217.75 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,214.5, 253.17 ,234.9
98300113,EAP,64616,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64616 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA CDM,1,261.00, 247.95 ,214.5, 247.95 , 217.75 , 217.75 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,214.5, 253.17 ,234.9
98300113,EAP,64616,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64616 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA CDM,1,261, 247.95 ,214.5, 247.95 , 217.75 , 217.75 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,214.5, 253.17 ,234.9
98300113,EAP,64616,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 64616 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA CDM,1,261, 247.95 ,214.5, 247.95 , 217.75 , 217.75 ,Current Medicare Rates,253.17,250.56,247.95,247.95,Included in ER Case rate,247.95,214.5, 253.17 ,234.9
98300188,EAP,93242,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 93242 EXTERNAL ECG REC>48HR<7D RECORDING CDM,1,116, 110.20 ,23.76, 110.20 , 24.12 , 24.12 ,Current Medicare Rates,112.52,111.36,110.2,110.2,Included in ER Case rate,110.2,23.76, 112.52 ,104.4
96910188,EAP,99442,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 99442 PHONE E/M BY PHYS 11-20 MIN,1,197, 187.15 ,128.7, 187.15 , 130.65 , 130.65 ,Current Medicare Rates,191.09,189.12,187.15,187.15,Included in ER Case rate,187.15,128.7, 191.09 ,177.3
96910005,EAP,CPT® 96110,,0983 - PROFESSIONAL FEES - CLINIC,DEVELOPMENTAL TEST LIM,1,24, 22.80 ,21.12, 22.80 , 21.44 , 21.44 ,Current Medicare Rates,23.28,23.04,22.8,22.8,Included in ER Case rate,22.8,21.12, 23.28 ,21.6
98310006,EAP,CPT® 99211,,0983 - PROFESSIONAL FEES - CLINIC,ESTAB PT VISIT - LEVEL 1,1,51, 48.45 ,17.16, 48.45 , 17.42 , 17.42 ,Current Medicare Rates,49.47,48.96,48.45,48.45,Included in ER Case rate,48.45,17.16, 49.47 ,45.9
98310007,EAP,CPT® 99212,,0983 - PROFESSIONAL FEES - CLINIC,ESTAB PT VISIT - LEVEL 2,1,113, 107.35 ,69.3, 107.35 , 70.35 , 70.35 ,Current Medicare Rates,109.61,108.48,107.35,107.35,Included in ER Case rate,107.35,69.3, 109.61 ,101.7
98310008,EAP,CPT® 99213,,0983 - PROFESSIONAL FEES - CLINIC,ESTAB PT VISIT - LEVEL 3,1,187.00, 177.65 ,128.7, 177.65 , 130.65 , 130.65 ,Current Medicare Rates,181.39,179.52,177.65,177.65,Included in ER Case rate,177.65,128.7, 181.39 ,168.3
98310010,EAP,CPT® 99215,,0983 - PROFESSIONAL FEES - CLINIC,ESTAB PT VISIT - LEVEL 5,1,374, 355.30 ,279.18, 355.30 , 283.41 , 283.41 ,Current Medicare Rates,362.78,359.04,355.3,355.3,Included in ER Case rate,355.3,279.18, 362.78 ,336.6
96910496,EAP,CPT® 11602,,0983 - PROFESSIONAL FEES - CLINIC,EXC TR-EXT MLG+MARG 1.1-2 CM,1,669.9, 636.41 ,316.14, 636.41 , 320.93 , 320.93 ,Current Medicare Rates,649.8,643.1,636.41,636.41,Included in ER Case rate,636.41,316.14, 649.80 ,602.91
98310202,EAP,CPT® 11104,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11104 Punch Biopsy Skin Single Lesion,1,232.00, 220.40 ,91.74, 220.40 , 93.13 , 93.13 ,Current Medicare Rates,225.04,222.72,220.4,220.4,Included in ER Case rate,220.4,91.74, 225.04 ,208.8
98310203,EAP,CPT® 11105,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11105 Punch Biopsy Skin Ea Sep/additional Lesion,1,74.00, 70.30 ,50.16, 70.30 , 50.92 , 50.92 ,Current Medicare Rates,71.78,71.04,70.3,70.3,Included in ER Case rate,70.3,50.16, 71.78 ,66.6
98310204,EAP,CPT® 11106,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11106 Incisional Biopsy Skin Single Lesion,1,232.00, 220.40 ,110.22, 220.40 , 111.89 , 111.89 ,Current Medicare Rates,225.04,222.72,220.4,220.4,Included in ER Case rate,220.4,110.22, 225.04 ,208.8
98310454,EAP,CPT® 11107,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11107 Incisional Biopsy Skin Ea Sep/additional Lesion,1,70, 66.50 ,60.06, 66.50 , 60.97 , 60.97 ,Current Medicare Rates,67.9,67.2,66.5,66.5,Included in ER Case rate,66.5,60.06, 67.90 ,63
98310345,EAP,CPT® 11305,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11305 Shave Skin Lesion 0.5 Cm Or Less Sclp Nk Hnd Ft Gen,1,268, 254.60 ,73.26, 254.60 , 74.37 , 74.37 ,Current Medicare Rates,259.96,257.28,254.6,254.6,Included in ER Case rate,254.6,73.26, 259.96 ,241.2
96910485,EAP,CPT® 11404,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11404 Exc Tr-ext B9+marg 3.1-4 Cm,1,536, 509.20 ,324.06, 509.20 , 328.97 , 328.97 ,Current Medicare Rates,519.92,514.56,509.2,509.2,Included in ER Case rate,509.2,324.06, 519.92 ,482.4
96910489,EAP,CPT® 11421,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11421 Exc H-f-nk-sp B9+marg 0.6-1,1,406, 385.70 ,215.82, 385.70 , 219.09 , 219.09 ,Current Medicare Rates,393.82,389.76,385.7,385.7,Included in ER Case rate,385.7,215.82, 393.82 ,365.4
96910492,EAP,CPT® 11441,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11441 Exc Face-mm B9+marg 0.6-1 Cm,1,436, 414.20 ,262.02, 414.20 , 265.99 , 265.99 ,Current Medicare Rates,422.92,418.56,414.2,414.2,Included in ER Case rate,414.2,262.02, 422.92 ,392.4
98310349,EAP,CPT® 11470,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11470 Removal Sweat Gland Lesion,1,982.00, 932.90 ,568.92, 932.90 , 577.54 , 577.54 ,Current Medicare Rates,952.54,942.72,932.9,932.9,Included in ER Case rate,932.9,568.92, 952.54 ,883.8
96910494,EAP,CPT® 11600,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11600 Exc Tr-ext Mlg+marg 0.5 < Cm,1,499.00, 474.05 ,240.24, 474.05 , 243.88 , 243.88 ,Current Medicare Rates,484.03,479.04,474.05,474.05,Included in ER Case rate,474.05,240.24, 484.03 ,449.1
96910495,EAP,CPT® 11601,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11601 Exc Tr-ext Mlg+marg 0.6-1 Cm,1,589, 559.55 ,291.06, 559.55 , 295.47 , 295.47 ,Current Medicare Rates,571.33,565.44,559.55,559.55,Included in ER Case rate,559.55,291.06, 571.33 ,530.1
96910535,EAP,CPT® 11603,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11603 Exc Tr-ext Mlg+marg 2.1-3 Cm,1,730.00, 693.50 ,378.84, 693.50 , 384.58 , 384.58 ,Current Medicare Rates,708.1,700.8,693.5,693.5,Included in ER Case rate,693.5,378.84, 708.10 ,657
96910498,EAP,CPT® 11721,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11721 Debride Nail 6 Or More,1,106, 100.70 ,46.2, 100.70 , 46.90 , 46.90 ,Current Medicare Rates,102.82,101.76,100.7,100.7,Included in ER Case rate,100.7,46.2, 102.82 ,95.4
96910501,EAP,CPT® 11900,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 11900 Injection Into Skin Lesions,1,122, 115.90 ,58.74, 115.90 , 59.63 , 59.63 ,Current Medicare Rates,118.34,117.12,115.9,115.9,Included in ER Case rate,115.9,58.74, 118.34 ,109.8
98310360,EAP,CPT® 12002,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 12002 Repair Superficial Wound(s) 2.6 To 7.5cm Slp Nk Ax Exgen T,1,244, 231.80 ,115.5, 231.80 , 117.25 , 117.25 ,Current Medicare Rates,236.68,234.24,231.8,231.8,Included in ER Case rate,231.8,115.5, 236.68 ,219.6
96910506,EAP,CPT® 17110,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 17110 Destruct B9 Lesion 1-14,1,286, 271.70 ,132, 271.70 , 134.00 , 134.00 ,Current Medicare Rates,277.42,274.56,271.7,271.7,Included in ER Case rate,271.7,132, 277.42 ,257.4
96910587,EAP,CPT® 19081,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19081 Bx Breast 1st Lesion Stereo,1,1637," 1,555.15 ",318.12," 1,555.15 ", 322.94 , 322.94 ,Current Medicare Rates,1587.89,1571.52,1555.15,1555.15,Included in ER Case rate,1555.15,318.12," 1,587.89 ",1473.3
96910589,EAP,CPT® 19083,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19083 Bx Breast 1st Lesion Us Imag,1,213, 202.35 ,298.98, 202.35 , 303.51 , 303.51 ,Current Medicare Rates,206.61,204.48,202.35,202.35,Included in ER Case rate,202.35,202.35, 303.51 ,191.7
96910590,EAP,CPT® 19084,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19084 Bx Breast Add Lesion Us Imag,1,97, 92.15 ,151.14, 92.15 , 153.43 , 153.43 ,Current Medicare Rates,94.09,93.12,92.15,92.15,Included in ER Case rate,92.15,92.15, 153.43 ,87.3
96910513,EAP,CPT® 19120,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19120 Removal Of Breast Lesion 1 Or More Lesions,1,1147," 1,089.65 ",827.64," 1,089.65 ", 840.18 , 840.18 ,Current Medicare Rates,1112.59,1101.12,1089.65,1089.65,Included in ER Case rate,1089.65,827.64," 1,112.59 ",1032.3
96910514,EAP,CPT® 19125,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19125 Excision Breast Lesion,1,"1,364.00"," 1,295.80 ",915.42," 1,295.80 ", 929.29 , 929.29 ,Current Medicare Rates,1323.08,1309.44,1295.8,1295.8,Included in ER Case rate,1295.8,915.42," 1,323.08 ",1227.6
96910593,EAP,CPT® 19281,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19281 Perq Device Loc Breast 1st Imag,1,562, 533.90 ,192.06, 533.90 , 194.97 , 194.97 ,Current Medicare Rates,545.14,539.52,533.9,533.9,Included in ER Case rate,533.9,192.06, 545.14 ,505.8
96910594,EAP,CPT® 19282,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19282 Perq Device Loc Breast Ea Imag,1,391, 371.45 ,97.02, 371.45 , 98.49 , 98.49 ,Current Medicare Rates,379.27,375.36,371.45,371.45,Included in ER Case rate,371.45,97.02, 379.27 ,351.9
96910009,EAP,CPT® 19294,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19294 Prep Tum Cav Iort Prtl Mast,1,394.00, 374.30 ,321.42, 374.30 , 326.29 , 326.29 ,Current Medicare Rates,382.18,378.24,374.3,374.3,Included in ER Case rate,374.3,321.42, 382.18 ,354.6
96910516,EAP,CPT® 19301,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19301 Partial Mastectomy,1,1565," 1,486.75 ",1306.14," 1,486.75 "," 1,325.93 "," 1,325.93 ",Current Medicare Rates,1518.05,1502.4,1486.75,1486.75,Included in ER Case rate,1486.75,1306.14," 1,518.05 ",1408.5
96910518,EAP,CPT® 19303,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 19303 Mast Simple Complete,1,2651," 2,518.45 ",1892.88," 2,518.45 "," 1,921.56 "," 1,921.56 ",Current Medicare Rates,2571.47,2544.96,2518.45,2518.45,Included in ER Case rate,2518.45,1892.88," 2,571.47 ",2385.9
96910519,EAP,CPT® 20526,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 20526 Ther Injection Carp Tunnel,1,312.00, 296.40 ,112.2, 296.40 , 113.90 , 113.90 ,Current Medicare Rates,302.64,299.52,296.4,296.4,Included in ER Case rate,296.4,112.2, 302.64 ,280.8
96911042,EAP,CPT® 20611,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 20611 Drain/inj Joint/bursa Major W/us,1,207.00, 196.65 ,117.48, 196.65 , 119.26 , 119.26 ,Current Medicare Rates,200.79,198.72,196.65,196.65,Included in ER Case rate,196.65,117.48, 200.79 ,186.3
96910723,EAP,CPT® 26070,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 26070 Arthrotomy W/explore/treat Hand Joint,1,"1,579.00"," 1,500.05 ",648.12," 1,500.05 ", 657.94 , 657.94 ,Current Medicare Rates,1531.63,1515.84,1500.05,1500.05,Included in ER Case rate,1500.05,648.12," 1,531.63 ",1421.1
98311017,EAP,CPT® 27788,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 27788 Closed Treatment Of Ankle Fracture W/manip,1,1506," 1,430.70 ",778.14," 1,430.70 ", 789.93 , 789.93 ,Current Medicare Rates,1460.82,1445.76,1430.7,1430.7,Included in ER Case rate,1430.7,778.14," 1,460.82 ",1355.4
96910798,EAP,CPT® 28820,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 28820 Amputation Of Toe,1,"1,305.00"," 1,239.75 ",348.48," 1,239.75 ", 353.76 , 353.76 ,Current Medicare Rates,1265.85,1252.8,1239.75,1239.75,Included in ER Case rate,1239.75,348.48," 1,265.85 ",1174.5
96910800,EAP,CPT® 29085,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 29085 Apply Hand/wrist Cast,1,251.00, 238.45 ,132.66, 238.45 , 134.67 , 134.67 ,Current Medicare Rates,243.47,240.96,238.45,238.45,Included in ER Case rate,238.45,132.66, 243.47 ,225.9
96910874,EAP,CPT® 29710,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 29710 Removal/revision Of Cast,1,103, 97.85 ,161.7, 97.85 , 164.15 , 164.15 ,Current Medicare Rates,99.91,98.88,97.85,97.85,Included in ER Case rate,97.85,97.85, 164.15 ,92.7
96910890,EAP,CPT® 29881,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 29881 Knee Arthroscopy/surgery Menisectomy,1,644, 611.80 ,1077.78, 611.80 ," 1,094.11 "," 1,094.11 ",Current Medicare Rates,624.68,618.24,611.8,611.8,Included in ER Case rate,611.8,611.8," 1,094.11 ",579.6
98311005,EAP,CPT® 30901,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 30901 Control Of Nosebleed Simple,1,326.00, 309.70 ,111.54, 309.70 , 113.23 , 113.23 ,Current Medicare Rates,316.22,312.96,309.7,309.7,Included in ER Case rate,309.7,111.54, 316.22 ,293.4
96910201,EAP,CPT® 36510,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 36510 Insert Umbilical Cath Vein,1,242.00, 229.90 ,103.62, 229.90 , 105.19 , 105.19 ,Current Medicare Rates,234.74,232.32,229.9,229.9,Included in ER Case rate,229.9,103.62, 234.74 ,217.8
98311035,EAP,CPT® 37609,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 37609 Temporal Artery Procedure,1,707, 671.65 ,402.6, 671.65 , 408.70 , 408.70 ,Current Medicare Rates,685.79,678.72,671.65,671.65,Included in ER Case rate,671.65,402.6, 685.79 ,636.3
96910211,EAP,CPT® 40812,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 40812 Excise/repair Mouth Lesion,1,428, 406.60 ,363, 406.60 , 368.50 , 368.50 ,Current Medicare Rates,415.16,410.88,406.6,406.6,Included in ER Case rate,406.6,363, 415.16 ,385.2
96910212,EAP,CPT® 43246,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 43246 Egd Place Gastrostomy Tube,1,461, 437.95 ,388.74, 437.95 , 394.63 , 394.63 ,Current Medicare Rates,447.17,442.56,437.95,437.95,Included in ER Case rate,437.95,388.74, 447.17 ,414.9
98310744,EAP,CPT® 44005,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 44005 Lysis Of Peritoneal Adhesions,1,"2,520.00"," 2,394.00 ",2147.64," 2,394.00 "," 2,180.18 "," 2,180.18 ",Current Medicare Rates,2444.4,2419.2,2394,2394,Included in ER Case rate,2394,2147.64," 2,444.40 ",2268
96910214,EAP,CPT® 44204,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 44204 Laparoscopy Partial Colectomy,1,3719," 3,533.05 ",3010.92," 3,533.05 "," 3,056.54 "," 3,056.54 ",Current Medicare Rates,3607.43,3570.24,3533.05,3533.05,Included in ER Case rate,3533.05,3010.92," 3,607.43 ",3347.1
96911101,EAP,CPT® 45349,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 45349 Sigmoidoscopy W/resection,1,499.00, 474.05 ,384.12, 474.05 , 389.94 , 389.94 ,Current Medicare Rates,484.03,479.04,474.05,474.05,Included in ER Case rate,474.05,384.12, 484.03 ,449.1
96911102,EAP,CPT® 45350,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 45350 Sgmdsc W/band Ligation,1,"1,309.00"," 1,243.55 ",195.36," 1,243.55 ", 198.32 , 198.32 ,Current Medicare Rates,1269.73,1256.64,1243.55,1243.55,Included in ER Case rate,1243.55,195.36," 1,269.73 ",1178.1
96911103,EAP,CPT® 45388,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 45388 Colonoscopy W/ablation,1,"7,350.00"," 6,982.50 ",524.7," 6,982.50 ", 532.65 , 532.65 ,Current Medicare Rates,7129.5,7056,6982.5,6982.5,Included in ER Case rate,6982.5,524.7," 7,129.50 ",6615
96911107,EAP,CPT® 45398,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 45398 Colonoscopy W/band Ligation,1,1644," 1,561.80 ",457.38," 1,561.80 ", 464.31 , 464.31 ,Current Medicare Rates,1594.68,1578.24,1561.8,1561.8,Included in ER Case rate,1561.8,457.38," 1,594.68 ",1479.6
96910221,EAP,CPT® 49520,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 49520 Rerepair Inguinal Hernia Reduce,1,1525," 1,448.75 ",1254," 1,448.75 "," 1,273.00 "," 1,273.00 ",Current Medicare Rates,1479.25,1464,1448.75,1448.75,Included in ER Case rate,1448.75,1254," 1,479.25 ",1372.5
98310440,EAP,CPT® 51701,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 51701 Insert Bladder Catheter,1,148.00, 140.60 ,49.5, 140.60 , 50.25 , 50.25 ,Current Medicare Rates,143.56,142.08,140.6,140.6,Included in ER Case rate,140.6,49.5, 143.56 ,133.2
96910238,EAP,CPT® 51705,,0983 - PROFESSIONAL FEES - CLINIC,"Hc Pr 51705 Change Of Bladder Tube, Simple",1,239.00, 227.05 ,100.32, 227.05 , 101.84 , 101.84 ,Current Medicare Rates,231.83,229.44,227.05,227.05,Included in ER Case rate,227.05,100.32, 231.83 ,215.1
96910292,EAP,CPT® 53620,,0983 - PROFESSIONAL FEES - CLINIC,"Hc Pr 53620 Dilate Urethra Stricture W/ Filiform Male, Initial",1,444, 421.80 ,168.3, 421.80 , 170.85 , 170.85 ,Current Medicare Rates,430.68,426.24,421.8,421.8,Included in ER Case rate,421.8,168.3, 430.68 ,399.6
98310177,EAP,CPT® 54100,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 54100 Biopsy Of Penis,1,471.00, 447.45 ,236.28, 447.45 , 239.86 , 239.86 ,Current Medicare Rates,456.87,452.16,447.45,447.45,Included in ER Case rate,447.45,236.28, 456.87 ,423.9
96910802,EAP,CPT® 54150,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 54150 Circumcision W/regional Block,1,401.00, 380.95 ,188.1, 380.95 , 190.95 , 190.95 ,Current Medicare Rates,388.97,384.96,380.95,380.95,Included in ER Case rate,380.95,188.1, 388.97 ,360.9
96910823,EAP,CPT® 54700,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 54700 Drainage Of Scrotum,1,488.00, 463.60 ,415.8, 463.60 , 422.10 , 422.10 ,Current Medicare Rates,473.36,468.48,463.6,463.6,Included in ER Case rate,463.6,415.8, 473.36 ,439.2
98310059,EAP,CPT® 56501,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 56501 Destroy Vulva Lesions Simple,1,324, 307.80 ,265.98, 307.80 , 270.01 , 270.01 ,Current Medicare Rates,314.28,311.04,307.8,307.8,Included in ER Case rate,307.8,265.98, 314.28 ,291.6
96910839,EAP,CPT® 57160,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 57160 Insert Pessary/other Device,1,198, 188.10 ,90.42, 188.10 , 91.79 , 91.79 ,Current Medicare Rates,192.06,190.08,188.1,188.1,Included in ER Case rate,188.1,90.42, 192.06 ,178.2
96910841,EAP,CPT® 57200,,0983 - PROFESSIONAL FEES - CLINIC,"Hc Pr 57200 Repair Of Vagina, Suture",1,1095," 1,040.25 ",658.68," 1,040.25 ", 668.66 , 668.66 ,Current Medicare Rates,1062.15,1051.2,1040.25,1040.25,Included in ER Case rate,1040.25,658.68," 1,062.15 ",985.5
96910848,EAP,CPT® 58100,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 58100 Biopsy Of Uterus Lining,1,282.00, 267.90 ,124.08, 267.90 , 125.96 , 125.96 ,Current Medicare Rates,273.54,270.72,267.9,267.9,Included in ER Case rate,267.9,124.08, 273.54 ,253.8
96910849,EAP,CPT® 58291,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 58291 Vaginal Hysterectomy Incl Tubes/ovary(s) Complex,1,2934," 2,787.30 ",2462.46," 2,787.30 "," 2,499.77 "," 2,499.77 ",Current Medicare Rates,2845.98,2816.64,2787.3,2787.3,Included in ER Case rate,2787.3,2462.46," 2,845.98 ",2640.6
96910850,EAP,CPT® 58300,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 58300 Insert Intrauterine Device,1,183, 173.85 ,99, 173.85 , 100.50 , 100.50 ,Current Medicare Rates,177.51,175.68,173.85,173.85,Included in ER Case rate,173.85,99, 177.51 ,164.7
98310068,EAP,CPT® 58600,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 58600 Division Of Fallopian Tube,1,858, 815.10 ,736.56, 815.10 , 747.72 , 747.72 ,Current Medicare Rates,832.26,823.68,815.1,815.1,Included in ER Case rate,815.1,736.56, 832.26 ,772.2
96910601,EAP,CPT® 59025,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59025 Fetal Non-stress Test,1,278, 264.10 ,96.36, 264.10 , 97.82 , 97.82 ,Current Medicare Rates,269.66,266.88,264.1,264.1,Included in ER Case rate,264.1,96.36, 269.66 ,250.2
98310432,EAP,CPT® 59400,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59400 Total Ob/vaginal Delivery/pp Care,1,"5,507.00"," 5,231.65 ",4744.08," 5,231.65 "," 4,815.96 "," 4,815.96 ",Current Medicare Rates,5341.79,5286.72,5231.65,5231.65,Included in ER Case rate,5231.65,4744.08," 5,341.79 ",4956.3
96910609,EAP,CPT® 59410,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59410 Vag Delivery W/postpartum,1,2768," 2,629.60 ",2094.84," 2,629.60 "," 2,126.58 "," 2,126.58 ",Current Medicare Rates,2684.96,2657.28,2629.6,2629.6,Included in ER Case rate,2629.6,2094.84," 2,684.96 ",2491.2
98310437,EAP,CPT® 59425,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59425 Antepartum Care Only Ob Visits (4-6),1,1261," 1,197.95 ",856.68," 1,197.95 ", 869.66 , 869.66 ,Current Medicare Rates,1223.17,1210.56,1197.95,1197.95,Included in ER Case rate,1197.95,856.68," 1,223.17 ",1134.9
98310401,EAP,CPT® 59426,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59426 Antepartum Care Only (7 Or More),1,2151," 2,043.45 ",1573.44," 2,043.45 "," 1,597.28 "," 1,597.28 ",Current Medicare Rates,2086.47,2064.96,2043.45,2043.45,Included in ER Case rate,2043.45,1573.44," 2,086.47 ",1935.9
98310434,EAP,CPT® 59510,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59510 Total Ob/cesarean Delivery/pp Car,1,6115," 5,809.25 ",5248.98," 5,809.25 "," 5,328.51 "," 5,328.51 ",Current Medicare Rates,5931.55,5870.4,5809.25,5809.25,Included in ER Case rate,5809.25,5248.98," 5,931.55 ",5503.5
96910638,EAP,CPT® 59514,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59514 Cesarean Delivery Only,1,"2,437.00"," 2,315.15 ",1790.58," 2,315.15 "," 1,817.71 "," 1,817.71 ",Current Medicare Rates,2363.89,2339.52,2315.15,2315.15,Included in ER Case rate,2315.15,1790.58," 2,363.89 ",2193.3
98310448,EAP,CPT® 59514,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 59514 Cesarean Delivery Only Asst,1,2207," 2,096.65 ",1790.58," 2,096.65 "," 1,817.71 "," 1,817.71 ",Current Medicare Rates,2140.79,2118.72,2096.65,2096.65,Included in ER Case rate,2096.65,1790.58," 2,140.79 ",1986.3
98311386,EAP,CPT® 64450,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 64450 Injection Anes Other Peripheral Nerve/branch Cdm,1,165.00, 156.75 ,81.84, 156.75 , 83.08 , 83.08 ,Current Medicare Rates,160.05,158.4,156.75,156.75,Included in ER Case rate,156.75,81.84, 160.05 ,148.5
96910026,EAP,HCPCS 86580,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 86580 Tb Intradermal Test,1,21.00, 19.95 ,19.8, 19.95 , 20.10 , 20.10 ,Current Medicare Rates,20.37,20.16,19.95,19.95,Included in ER Case rate,19.95,19.8, 20.37 ,18.9
96910639,EAP,CPT® 90473,,0983 - PROFESSIONAL FEES - CLINIC,"Hc Pr 90473 Immuniz Admin,intranasal/oral,1 Vac/tox",1,66.00, 62.70 ,32.34, 62.70 , 32.83 , 32.83 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,32.34, 64.02 ,59.4
96910340,EAP,HCPCS 90473,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 90473 Vfc Immune Admin Oral/nasal Initial,1,0.01, 0.01 ,32.34, 0.01 , 32.83 , 32.83 ,Current Medicare Rates,0.01,0.01,0.01,0.01,Included in ER Case rate,0.01,0.01, 32.83 ,0.009
96910341,EAP,HCPCS 90474,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 90474 Vfc Immune Admin Oral/nasal Addl,1,0.01, 0.01 ,23.1, 0.01 , 23.45 , 23.45 ,Current Medicare Rates,0.01,0.01,0.01,0.01,Included in ER Case rate,0.01,0.01, 23.45 ,0.009
98310037,EAP,CPT® 93792,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 93792 Pt/caregiver Trainj Home Inr,1,127.00, 120.65 ,138.6, 120.65 , 140.70 , 140.70 ,Current Medicare Rates,123.19,121.92,120.65,120.65,Included in ER Case rate,120.65,120.65, 140.70 ,114.3
98310038,EAP,CPT® 93793,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 93793 Anticoag Mgmt Pt Warfarin,1,0.01, 0.01 ,22.44, 0.01 , 22.78 , 22.78 ,Current Medicare Rates,0.01,0.01,0.01,0.01,Included in ER Case rate,0.01,0.01, 22.78 ,0.009
96910466,EAP,CPT® 95117,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 95117 Immunotherapy Injections,1,27.00, 25.65 ,23.1, 25.65 , 23.45 , 23.45 ,Current Medicare Rates,26.19,25.92,25.65,25.65,Included in ER Case rate,25.65,23.1, 26.19 ,24.3
96911437,EAP,CPT® 96160,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 96160 Hlth Rsk Assess Pt Focused,1,0.00, -   ,5.28, -   , 5.36 , 5.36 ,Current Medicare Rates,0,0,0,0,Included in ER Case rate,0,0, 5.36 ,0
96910468,EAP,CPT® 96360,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 96360 Hydration Iv Infusion Init,1,148.00, 140.60 ,64.02, 140.60 , 64.99 , 64.99 ,Current Medicare Rates,143.56,142.08,140.6,140.6,Included in ER Case rate,140.6,64.02, 143.56 ,133.2
96910470,EAP,CPT® 96365,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 96365 Ther/proph/diag Iv Inf Init,1,120.00, 114.00 ,126.06, 114.00 , 127.97 , 127.97 ,Current Medicare Rates,116.4,115.2,114,114,Included in ER Case rate,114,114, 127.97 ,108
96910641,EAP,CPT® 96523,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 96523 Irrig Implanted Drug Delivery Device,1,64.00, 60.80 ,50.16, 60.80 , 50.92 , 50.92 ,Current Medicare Rates,62.08,61.44,60.8,60.8,Included in ER Case rate,60.8,50.16, 62.08 ,57.6
98310134,EAP,CPT® 98925,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 98925 9 Osteopathic Manipulation - 1-2 Body Regions,1,70.00, 66.50 ,45.54, 66.50 , 46.23 , 46.23 ,Current Medicare Rates,67.9,67.2,66.5,66.5,Included in ER Case rate,66.5,45.54, 67.90 ,63
98310135,EAP,CPT® 98926,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 98926 Osteopathic Manipulation - 3-4 Body Regions,1,103, 97.85 ,67.98, 97.85 , 69.01 , 69.01 ,Current Medicare Rates,99.91,98.88,97.85,97.85,Included in ER Case rate,97.85,67.98, 99.91 ,92.7
98310136,EAP,CPT® 98927,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 98927 Osteopathic Manipulation - 5-6 Body Regions,1,132, 125.40 ,89.1, 125.40 , 90.45 , 90.45 ,Current Medicare Rates,128.04,126.72,125.4,125.4,Included in ER Case rate,125.4,89.1, 128.04 ,118.8
98310137,EAP,CPT® 98928,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 98928 Osteopathic Manipulation - 7-8 Body Regions,1,163.00, 154.85 ,113.52, 154.85 , 115.24 , 115.24 ,Current Medicare Rates,158.11,156.48,154.85,154.85,Included in ER Case rate,154.85,113.52, 158.11 ,146.7
98310138,EAP,CPT® 98929,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 98929 Osteopathic Manipulation - 9-10 Body Regions,1,203.00, 192.85 ,135.96, 192.85 , 138.02 , 138.02 ,Current Medicare Rates,196.91,194.88,192.85,192.85,Included in ER Case rate,192.85,135.96, 196.91 ,182.7
96910961,EAP,CPT® 98968,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 98968 Phone Assessment By Nonphysician 21-30 Min Cdm,1,129, 122.55 ,60.72, 122.55 , 61.64 , 61.64 ,Current Medicare Rates,125.13,123.84,122.55,122.55,Included in ER Case rate,122.55,60.72, 125.13 ,116.1
98310003,EAP,CPT® 99203,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 99203 NEW PT VISIT - LEVEL 3,1,280.00, 266.00 ,161.7, 266.00 , 164.15 , 164.15 ,Current Medicare Rates,271.6,268.8,266,266,Included in ER Case rate,266,161.7, 271.60 ,252
98310009,EAP,CPT® 99214,,0983 - PROFESSIONAL FEES - CLINIC,HC PR 99214 ESTAB PT VISIT - LEVEL 4,1,277, 263.15 ,190.08, 263.15 , 192.96 , 192.96 ,Current Medicare Rates,268.69,265.92,263.15,263.15,Included in ER Case rate,263.15,190.08, 268.69 ,249.3
96910101,EAP,CPT® 99304,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99304 Nursing Facility Care Init Level 1,1,248, 235.60 ,157.08, 235.60 , 159.46 , 159.46 ,Current Medicare Rates,240.56,238.08,235.6,235.6,Included in ER Case rate,235.6,157.08, 240.56 ,223.2
96910102,EAP,CPT® 99305,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99305 Nursing Facility Care Init Level 2,1,336, 319.20 ,260.04, 319.20 , 263.98 , 263.98 ,Current Medicare Rates,325.92,322.56,319.2,319.2,Included in ER Case rate,319.2,260.04, 325.92 ,302.4
96910104,EAP,CPT® 99307,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99307 Nursing Fac Care Subseq Level 1,1,114, 108.30 ,77.22, 108.30 , 78.39 , 78.39 ,Current Medicare Rates,110.58,109.44,108.3,108.3,Included in ER Case rate,108.3,77.22, 110.58 ,102.6
96910105,EAP,CPT® 99308,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99308 Nursing Fac Care Subseq Level 2,1,176, 167.20 ,145.2, 167.20 , 147.40 , 147.40 ,Current Medicare Rates,170.72,168.96,167.2,167.2,Included in ER Case rate,167.2,145.2, 170.72 ,158.4
96910106,EAP,CPT® 99309,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99309 Nursing Fac Care Subseqlevel 3,1,234, 222.30 ,207.9, 222.30 , 211.05 , 211.05 ,Current Medicare Rates,226.98,224.64,222.3,222.3,Included in ER Case rate,222.3,207.9, 226.98 ,210.6
96910108,EAP,CPT® 99315,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99315 Nursing Fac Discharge Day 30min/less,1,188, 178.60 ,159.06, 178.60 , 161.47 , 161.47 ,Current Medicare Rates,182.36,180.48,178.6,178.6,Included in ER Case rate,178.6,159.06, 182.36 ,169.2
96910109,EAP,CPT® 99316,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99316 Nursing Fac Discharge Day 30min/more,1,271, 257.45 ,256.08, 257.45 , 259.96 , 259.96 ,Current Medicare Rates,262.87,260.16,257.45,257.45,Included in ER Case rate,257.45,256.08, 262.87 ,243.9
96910122,EAP,CPT® 99347,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99347 Home Visit Est Patient Level 1,1,230, 218.50 ,87.12, 218.50 , 88.44 , 88.44 ,Current Medicare Rates,223.1,220.8,218.5,218.5,Included in ER Case rate,218.5,87.12, 223.10 ,207
96910123,EAP,CPT® 99348,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99348 Home Visit Est Patient Level 2,1,240, 228.00 ,148.5, 228.00 , 150.75 , 150.75 ,Current Medicare Rates,232.8,230.4,228,228,Included in ER Case rate,228,148.5, 232.80 ,216
96910124,EAP,CPT® 99349,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99349 Home Visit Est Patient Level 3,1,330, 313.50 ,248.82, 313.50 , 252.59 , 252.59 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,248.82, 320.10 ,297
96910144,EAP,CPT® 99381,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99381 Init Pm E/m New Pat Inf,1,286, 271.70 ,143.88, 271.70 , 146.06 , 146.06 ,Current Medicare Rates,277.42,274.56,271.7,271.7,Included in ER Case rate,271.7,143.88, 277.42 ,257.4
96910147,EAP,CPT® 99382,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99382 Init Pm E/m New Pat 1-4 Yrs,1,299, 284.05 ,153.12, 284.05 , 155.44 , 155.44 ,Current Medicare Rates,290.03,287.04,284.05,284.05,Included in ER Case rate,284.05,153.12, 290.03 ,269.1
96910149,EAP,CPT® 99383,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99383 Prev Visit New Age 5-11,1,310, 294.50 ,162.36, 294.50 , 164.82 , 164.82 ,Current Medicare Rates,300.7,297.6,294.5,294.5,Included in ER Case rate,294.5,162.36, 300.70 ,279
96910152,EAP,CPT® 99384,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99384 Prev Visit New Age 12-17,1,351, 333.45 ,190.74, 333.45 , 193.63 , 193.63 ,Current Medicare Rates,340.47,336.96,333.45,333.45,Included in ER Case rate,333.45,190.74, 340.47 ,315.9
96910154,EAP,CPT® 99385,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99385 Prev Visit New Age 18-39,1,342, 324.90 ,183.48, 324.90 , 186.26 , 186.26 ,Current Medicare Rates,331.74,328.32,324.9,324.9,Included in ER Case rate,324.9,183.48, 331.74 ,307.8
96910156,EAP,CPT® 99386,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99386 Prev Visit New Age 40-64,1,394, 374.30 ,222.42, 374.30 , 225.79 , 225.79 ,Current Medicare Rates,382.18,378.24,374.3,374.3,Included in ER Case rate,374.3,222.42, 382.18 ,354.6
96910158,EAP,CPT® 99387,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99387 Init Pm E/m New Pat 65+ Yrs,1,407, 386.65 ,239.58, 386.65 , 243.21 , 243.21 ,Current Medicare Rates,394.79,390.72,386.65,386.65,Included in ER Case rate,386.65,239.58, 394.79 ,366.3
96910161,EAP,CPT® 99391,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99391 Per Pm Reeval Est Pat Inf,1,257, 244.15 ,130.68, 244.15 , 132.66 , 132.66 ,Current Medicare Rates,249.29,246.72,244.15,244.15,Included in ER Case rate,244.15,130.68, 249.29 ,231.3
96910163,EAP,CPT® 99392,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99392 Prev Visit Est Age 1-4,1,274, 260.30 ,143.88, 260.30 , 146.06 , 146.06 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,143.88, 265.78 ,246.6
96910165,EAP,CPT® 99393,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99393 Prev Visit Est Age 5-11,1,274, 260.30 ,143.88, 260.30 , 146.06 , 146.06 ,Current Medicare Rates,265.78,263.04,260.3,260.3,Included in ER Case rate,260.3,143.88, 265.78 ,246.6
96910167,EAP,CPT® 99394,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99394 Prev Visit Est Age 12-17,1,299, 284.05 ,162.36, 284.05 , 164.82 , 164.82 ,Current Medicare Rates,290.03,287.04,284.05,284.05,Included in ER Case rate,284.05,162.36, 290.03 ,269.1
96910170,EAP,CPT® 99395,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99395 Prev Visit Est Age 18-39,1,307, 291.65 ,167.64, 291.65 , 170.18 , 170.18 ,Current Medicare Rates,297.79,294.72,291.65,291.65,Included in ER Case rate,291.65,167.64, 297.79 ,276.3
96910172,EAP,CPT® 99396,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99396 Prev Visit Est Age 40-64,1,328, 311.60 ,181.5, 311.60 , 184.25 , 184.25 ,Current Medicare Rates,318.16,314.88,311.6,311.6,Included in ER Case rate,311.6,181.5, 318.16 ,295.2
96910174,EAP,CPT® 99397,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99397 Per Pm Reeval Est Pat 65+ Yr,1,352, 334.40 ,190.74, 334.40 , 193.63 , 193.63 ,Current Medicare Rates,341.44,337.92,334.4,334.4,Included in ER Case rate,334.4,190.74, 341.44 ,316.8
96910176,EAP,CPT® 99401,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99401 Preventive Counseling Indiv 15 Min,1,81, 76.95 ,46.86, 76.95 , 47.57 , 47.57 ,Current Medicare Rates,78.57,77.76,76.95,76.95,Included in ER Case rate,76.95,46.86, 78.57 ,72.9
98311066,EAP,CPT® 99421,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99421 Online Digital E/m Svc Est Pt <7 D 5-10 Minutes Cdm,1,35, 33.25 ,25.08, 33.25 , 25.46 , 25.46 ,Current Medicare Rates,33.95,33.6,33.25,33.25,Included in ER Case rate,33.25,25.08, 33.95 ,31.5
96910630,EAP,CPT® 99460,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99460 Newborn Care,1,257, 244.15 ,180.84, 244.15 , 183.58 , 183.58 ,Current Medicare Rates,249.29,246.72,244.15,244.15,Included in ER Case rate,244.15,180.84, 249.29 ,231.3
96910631,EAP,CPT® 99462,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99462 Newborn Hospital Visit,1,108, 102.60 ,79.86, 102.60 , 81.07 , 81.07 ,Current Medicare Rates,104.76,103.68,102.6,102.6,Included in ER Case rate,102.6,79.86, 104.76 ,97.2
96910632,EAP,CPT® 99463,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99463 Newborn Discharge Same Day,1,309, 293.55 ,212.52, 293.55 , 215.74 , 215.74 ,Current Medicare Rates,299.73,296.64,293.55,293.55,Included in ER Case rate,293.55,212.52, 299.73 ,278.1
96910633,EAP,CPT® 99464,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99464 Attendance/delivery,1,192, 182.40 ,141.9, 182.40 , 144.05 , 144.05 ,Current Medicare Rates,186.24,184.32,182.4,182.4,Included in ER Case rate,182.4,141.9, 186.24 ,172.8
96910634,EAP,CPT® 99465,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99465 Critical Care - Newborn,1,408, 387.60 ,275.88, 387.60 , 280.06 , 280.06 ,Current Medicare Rates,395.76,391.68,387.6,387.6,Included in ER Case rate,387.6,275.88, 395.76 ,367.2
98310451,EAP,CPT® 99477,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99477 Init Day Neonate Care,1,933, 886.35 ,660.66, 886.35 , 670.67 , 670.67 ,Current Medicare Rates,905.01,895.68,886.35,886.35,Included in ER Case rate,886.35,660.66, 905.01 ,839.7
96910018,EAP,CPT® 99483,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99483 Assmt & Care Pln Pt Cog Imp,1,560.00, 532.00 ,378.18, 532.00 , 383.91 , 383.91 ,Current Medicare Rates,543.2,537.6,532,532,Included in ER Case rate,532,378.18, 543.20 ,504
98311141,EAP,CPT® 99490,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99490 Chron Care Management Srvc 20 Min Per Month,1,100, 95.00 ,98.34, 95.00 , 99.83 , 99.83 ,Current Medicare Rates,97,96,95,95,Included in ER Case rate,95,95, 99.83 ,90
96910402,EAP,CPT® 99491,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr 99491 Chronic Care Mgmt Svc At Least 30 Min Per Month,1,125, 118.75 ,147.18, 118.75 , 149.41 , 149.41 ,Current Medicare Rates,121.25,120,118.75,118.75,Included in ER Case rate,118.75,118.75, 149.41 ,112.5
96910436,EAP,HCPCS G0101,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0101 Screen;pelvic/breast Exam,1,99, 94.05 ,54.12, 94.05 , 54.94 , 54.94 ,Current Medicare Rates,96.03,95.04,94.05,94.05,Included in ER Case rate,94.05,54.12, 96.03 ,89.1
96910316,EAP,HCPCS G0402,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0402 Initial Preventive Exam Mc,1,213, 202.35 ,256.08, 202.35 , 259.96 , 259.96 ,Current Medicare Rates,206.61,204.48,202.35,202.35,Included in ER Case rate,202.35,202.35, 259.96 ,191.7
98310523,EAP,HCPCS G0403,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0403 Ekg For Initial Prevent Exam,1,41, 38.95 ,28.38, 38.95 , 28.81 , 28.81 ,Current Medicare Rates,39.77,39.36,38.95,38.95,Included in ER Case rate,38.95,28.38, 39.77 ,36.9
98310302,EAP,HCPCS G0404,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0404 Ecg 12 Lead Tracing Mcare Screen,1,19, 18.05 ,12.54, 18.05 , 12.73 , 12.73 ,Current Medicare Rates,18.43,18.24,18.05,18.05,Included in ER Case rate,18.05,12.54, 18.43 ,17.1
98310167,EAP,HCPCS G0405,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0405 Ecg 12 Lead Interp & Rept Mcare Scn,1,20, 19.00 ,15.84, 19.00 , 16.08 , 16.08 ,Current Medicare Rates,19.4,19.2,19,19,Included in ER Case rate,19,15.84, 19.40 ,18
98310030,EAP,HCPCS G0438,,0983 - PROFESSIONAL FEES - CLINIC,"Hc Pr G0438 Ppps, Initial Visit",1,372, 353.40 ,324.06, 353.40 , 328.97 , 328.97 ,Current Medicare Rates,360.84,357.12,353.4,353.4,Included in ER Case rate,353.4,324.06, 360.84 ,334.8
98310916,EAP,HCPCS G0442,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0442 Annual Alcohol Screen 15 Min,1,46, 43.70 ,17.82, 43.70 , 18.09 , 18.09 ,Current Medicare Rates,44.62,44.16,43.7,43.7,Included in ER Case rate,43.7,17.82, 44.62 ,41.4
98310969,EAP,HCPCS G0444,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0444 Depression Screen Annual,1,46, 43.70 ,17.82, 43.70 , 18.09 , 18.09 ,Current Medicare Rates,44.62,44.16,43.7,43.7,Included in ER Case rate,43.7,17.82, 44.62 ,41.4
98310045,EAP,HCPCS G0511,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0511 Ccm/bhi By Rhc/fqhc 20min Mo,1,151.00, 143.45 ,87.12, 143.45 , 88.44 , 88.44 ,Current Medicare Rates,146.47,144.96,143.45,143.45,Included in ER Case rate,143.45,87.12, 146.47 ,135.9
98310050,EAP,HCPCS G0512,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr G0512 Cocm By Rhc/fqhc 60 Min Mo,1,335, 318.25 ,286.44, 318.25 , 290.78 , 290.78 ,Current Medicare Rates,324.95,321.6,318.25,318.25,Included in ER Case rate,318.25,286.44, 324.95 ,301.5
98310085,EAP,HCPCS G0513,,0983 - PROFESSIONAL FEES - CLINIC,"Hc Pr G0513 Prolong Prev Svcs, First 30m",1,150, 142.50 ,115.5, 142.50 , 117.25 , 117.25 ,Current Medicare Rates,145.5,144,142.5,142.5,Included in ER Case rate,142.5,115.5, 145.50 ,135
98310070,EAP,HCPCS G0514,,0983 - PROFESSIONAL FEES - CLINIC,"Hc Pr G0514 Prolong Prev Svcs, Addl 30m",1,150, 142.50 ,116.16, 142.50 , 117.92 , 117.92 ,Current Medicare Rates,145.5,144,142.5,142.5,Included in ER Case rate,142.5,116.16, 145.50 ,135
96910103,EAP,CPT® 99306,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr Nursing Facility Care Init Level 3,1,429, 407.55 ,355.08, 407.55 , 360.46 , 360.46 ,Current Medicare Rates,416.13,411.84,407.55,407.55,Included in ER Case rate,407.55,355.08, 416.13 ,386.1
98310031,EAP,HCPCS G0439,,0983 - PROFESSIONAL FEES - CLINIC,"HC PR PPPS, SUBSEQ VISIT",1,335, 318.25 ,253.44, 318.25 , 257.28 , 257.28 ,Current Medicare Rates,324.95,321.6,318.25,318.25,Included in ER Case rate,318.25,253.44, 324.95 ,301.5
96910439,EAP,HCPCS Q0091,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr Q0091 Obtaining Screen Pap Smear,1,116.00, 110.20 ,35.64, 110.20 , 36.18 , 36.18 ,Current Medicare Rates,112.52,111.36,110.2,110.2,Included in ER Case rate,110.2,35.64, 112.52 ,104.4
98310206,EAP,CPT® 11103,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr Tangential Biopsy Skin Ea Sep/additional Lesion,1,74, 70.30 ,42.24, 70.30 , 42.88 , 42.88 ,Current Medicare Rates,71.78,71.04,70.3,70.3,Included in ER Case rate,70.3,42.24, 71.78 ,66.6
98310205,EAP,CPT® 11102,,0983 - PROFESSIONAL FEES - CLINIC,Hc Pr Tangential Biopsy Skin Single Lesion,1,232, 220.40 ,73.92, 220.40 , 75.04 , 75.04 ,Current Medicare Rates,225.04,222.72,220.4,220.4,Included in ER Case rate,220.4,73.92, 225.04 ,208.8
98310002,EAP,CPT® 99202,,0983 - PROFESSIONAL FEES - CLINIC,NEW PT VISIT - LEVEL 2,1,191, 181.45 ,93.72, 181.45 , 95.14 , 95.14 ,Current Medicare Rates,185.27,183.36,181.45,181.45,Included in ER Case rate,181.45,93.72, 185.27 ,171.9
98310004,EAP,CPT® 99204,,0983 - PROFESSIONAL FEES - CLINIC,NEW PT VISIT - LEVEL 4,1,424, 402.80 ,260.04, 402.80 , 263.98 , 263.98 ,Current Medicare Rates,411.28,407.04,402.8,402.8,Included in ER Case rate,402.8,260.04, 411.28 ,381.6
98310005,EAP,CPT® 99205,,0983 - PROFESSIONAL FEES - CLINIC,NEW PT VISIT - LEVEL 5,1,533, 506.35 ,353.1, 506.35 , 358.45 , 358.45 ,Current Medicare Rates,517.01,511.68,506.35,506.35,Included in ER Case rate,506.35,353.1, 517.01 ,479.7
98510002,EAP,93016,,0985 - PROFESSIONAL FEES - EKG,HC PR 93016 CARDIO STRESS TEST PHYS SUPV ONLY,1,74, 70.30 ,40.92, 70.30 , 41.54 , 41.54 ,Current Medicare Rates,71.78,71.04,70.3,70.3,Included in ER Case rate,70.3,40.92, 71.78 ,66.6
98510002,EAP,93016,,0985 - PROFESSIONAL FEES - EKG,HC PR 93016 CARDIO STRESS TEST PHYS SUPV ONLY,1,74, 70.30 ,40.92, 70.30 , 41.54 , 41.54 ,Current Medicare Rates,71.78,71.04,70.3,70.3,Included in ER Case rate,70.3,40.92, 71.78 ,66.6
98510002,EAP,93016,,0985 - PROFESSIONAL FEES - EKG,HC PR 93016 CARDIO STRESS TEST PHYS SUPV ONLY,1,74, 70.30 ,40.92, 70.30 , 41.54 , 41.54 ,Current Medicare Rates,71.78,71.04,70.3,70.3,Included in ER Case rate,70.3,40.92, 71.78 ,66.6
98510003,EAP,93018,,0985 - PROFESSIONAL FEES - EKG,HC PR 93018 CARDIO STRESS TEST INTERP & REPT,1,49, 46.55 ,27.06, 46.55 , 27.47 , 27.47 ,Current Medicare Rates,47.53,47.04,46.55,46.55,Included in ER Case rate,46.55,27.06, 47.53 ,44.1
98510003,EAP,93018,,0985 - PROFESSIONAL FEES - EKG,HC PR 93018 CARDIO STRESS TEST INTERP & REPT,1,49, 46.55 ,27.06, 46.55 , 27.47 , 27.47 ,Current Medicare Rates,47.53,47.04,46.55,46.55,Included in ER Case rate,46.55,27.06, 47.53 ,44.1
98510003,EAP,93018,,0985 - PROFESSIONAL FEES - EKG,HC PR 93018 CARDIO STRESS TEST INTERP & REPT,1,49.00, 46.55 ,27.06, 46.55 , 27.47 , 27.47 ,Current Medicare Rates,47.53,47.04,46.55,46.55,Included in ER Case rate,46.55,27.06, 47.53 ,44.1
98510009,EAP,CPT® 93000,,0985 - PROFESSIONAL FEES - EKG,Hc Pr 93000 Ecg 12 Lead W/interp & Report,1,45, 42.75 ,28.38, 42.75 , 28.81 , 28.81 ,Current Medicare Rates,43.65,43.2,42.75,42.75,Included in ER Case rate,42.75,28.38, 43.65 ,40.5
98510001,EAP,CPT® 93010,,0985 - PROFESSIONAL FEES - EKG,Hc Pr 93010 Ecg 12 Lead Interp & Rept Only,1,22, 20.90 ,15.84, 20.90 , 16.08 , 16.08 ,Current Medicare Rates,21.34,21.12,20.9,20.9,Included in ER Case rate,20.9,15.84, 21.34 ,19.8
98510004,EAP,CPT® 93042,,0985 - PROFESSIONAL FEES - EKG,Hc Pr 93042 Rhythm Ecg Interp & Rept Only,1,17, 16.15 ,13.2, 16.15 , 13.40 , 13.40 ,Current Medicare Rates,16.49,16.32,16.15,16.15,Included in ER Case rate,16.15,13.2, 16.49 ,15.3
98510024,EAP,CPT® 93351,,0985 - PROFESSIONAL FEES - EKG,Hc Pr 93351 Echo Stress W/interp Rept & Monitor,1,447, 424.65 ,457.38, 424.65 , 464.31 , 464.31 ,Current Medicare Rates,433.59,429.12,424.65,424.65,Included in ER Case rate,424.65,424.65, 464.31 ,402.3
98710011,EAP,CPT® 99231,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,Hc Pr 99231 Subsequent Hospital Care Level 1,1,101, 95.95 ,97.02, 95.95 , 98.49 , 98.49 ,Current Medicare Rates,97.97,96.96,95.95,95.95,Included in ER Case rate,95.95,95.95, 98.49 ,90.9
98710013,EAP,CPT® 99233,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,Hc Pr 99233 Subsequent Hospital Care Level 3,1,269, 255.55 ,232.32, 255.55 , 235.84 , 235.84 ,Current Medicare Rates,260.93,258.24,255.55,255.55,Included in ER Case rate,255.55,232.32, 260.93 ,242.1
98710024,EAP,CPT® 99234,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,Hc Pr 99234 Observ/hosp Same Date/low Cmplx,1,345, 327.75 ,192.72, 327.75 , 195.64 , 195.64 ,Current Medicare Rates,334.65,331.2,327.75,327.75,Included in ER Case rate,327.75,192.72, 334.65 ,310.5
98710025,EAP,CPT® 99235,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,Hc Pr 99235 Observ/hosp Same Date/mod Cmplx,1,436, 414.20 ,310.86, 414.20 , 315.57 , 315.57 ,Current Medicare Rates,422.92,418.56,414.2,414.2,Included in ER Case rate,414.2,310.86, 422.92 ,392.4
98710026,EAP,CPT® 99236,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,Hc Pr 99236 Observ/hosp Same Date/high Cmplx,1,562, 533.90 ,407.22, 533.90 , 413.39 , 413.39 ,Current Medicare Rates,545.14,539.52,533.9,533.9,Included in ER Case rate,533.9,407.22, 545.14 ,505.8
98710017,EAP,CPT® 99238,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,HOSPITAL DISCHARGE DAY < 30 MINUTES,1,188, 178.60 ,157.74, 178.60 , 160.13 , 160.13 ,Current Medicare Rates,182.36,180.48,178.6,178.6,Included in ER Case rate,178.6,157.74, 182.36 ,169.2
98710018,EAP,CPT® 99239,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,HOSPITAL DISCHARGE DAY > 30 MINUTES,1,277, 263.15 ,223.74, 263.15 , 227.13 , 227.13 ,Current Medicare Rates,268.69,265.92,263.15,263.15,Included in ER Case rate,263.15,223.74, 268.69 ,249.3
98710005,EAP,CPT® 99221,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,INITIAL HOSPITAL CARE LEVEL 1,1,263, 249.85 ,162.36, 249.85 , 164.82 , 164.82 ,Current Medicare Rates,255.11,252.48,249.85,249.85,Included in ER Case rate,249.85,162.36, 255.11 ,236.7
98710006,EAP,CPT® 99222,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,INITIAL HOSPITAL CARE LEVEL 2,1,355, 337.25 ,254.1, 337.25 , 257.95 , 257.95 ,Current Medicare Rates,344.35,340.8,337.25,337.25,Included in ER Case rate,337.25,254.1, 344.35 ,319.5
98710007,EAP,CPT® 99223,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,INITIAL HOSPITAL CARE LEVEL 3,1,524, 497.80 ,338.58, 497.80 , 343.71 , 343.71 ,Current Medicare Rates,508.28,503.04,497.8,497.8,Included in ER Case rate,497.8,338.58, 508.28 ,471.6
98710012,EAP,CPT® 99232,,0987 - PROFESSIONAL FEES - HOSPITAL VISIT,SUBSEQUENT HOSPITAL CARE LEVEL 2,1,187, 177.65 ,154.44, 177.65 , 156.78 , 156.78 ,Current Medicare Rates,181.39,179.52,177.65,177.65,Included in ER Case rate,177.65,154.44, 181.39 ,168.3
98810007,EAP,CPT® 99252,,0988 - PROFESSIONAL FEES - CONSULTATION,INPATIENT CONSULTATION LEVEL 2,1,168, 159.60 ,139.92, 159.60 , 142.04 , 142.04 ,Current Medicare Rates,162.96,161.28,159.6,159.6,Included in ER Case rate,159.6,139.92, 162.96 ,151.2
98810008,EAP,CPT® 99253,,0988 - PROFESSIONAL FEES - CONSULTATION,INPATIENT CONSULTATION LEVEL 3,1,284, 269.80 ,195.36, 269.80 , 198.32 , 198.32 ,Current Medicare Rates,275.48,272.64,269.8,269.8,Included in ER Case rate,269.8,195.36, 275.48 ,255.6
98810003,EAP,CPT® 99243,,0988 - PROFESSIONAL FEES - CONSULTATION,OFFICE CONSULTATION LEVEL 3,1,272, 258.40 ,172.92, 258.40 , 175.54 , 175.54 ,Current Medicare Rates,263.84,261.12,258.4,258.4,Included in ER Case rate,258.4,172.92, 263.84 ,244.8
30010447,EAP,CPT  86215,,0302,HC DEOXYRIBONUCLEASE ANTIBODY,1,44, 41.80 ,43.12, 41.80 , 42.68 , 41.80 ,Current Medicare Rates,42.68,42.24,41.8,41.8,Included in ER Case rate,41.8,41.8, 43.12 ,39.6
30011299,EAP,CPT  87253,,0306,HC VIRUS INOCULATE TISSUE ADDL - TISSUE TYPING FOR ID,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,64.6,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30011315,EAP,CPT  87273,,0306,HC HERPES SIMPLEX 2 AG IF,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,38,38,Included in ER Case rate,38,38, 39.20 ,36
30011316,EAP,CPT  87274,,0306,HC HERPES SIMPLEX 1 AG IF - DFA,1,40, 38.00 ,39.2, 38.00 , 38.80 , 38.00 ,Current Medicare Rates,38.8,38.4,38,38,Included in ER Case rate,38,38, 39.20 ,36
30011762,EAP,CPT  87899,,0306,HC STREP PNEUMONIAE AG URINE,1,48, 45.60 ,47.04, 45.60 , 46.56 , 45.60 ,Current Medicare Rates,46.56,46.08,45.6,45.6,Included in ER Case rate,45.6,45.6, 47.04 ,43.2
30011990,EAP,CPT  81381,,0310,HC HLA-B 1502 TYPING,1,536, 509.20 ,525.28, 509.20 , 519.92 , 509.20 ,Current Medicare Rates,519.92,514.56,509.2,509.2,Included in ER Case rate,509.2,509.2, 525.28 ,482.4
30013049,EAP,CPT  84255,,0301,HC SELENIUM,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,95,95,Included in ER Case rate,95,95, 98.00 ,90
30016339,EAP,CPT  87653,,0306,HC STREP B DNA AMPLIFIED PROBE,1,110, 104.50 ,107.8, 104.50 , 106.70 , 104.50 ,Current Medicare Rates,106.7,105.6,104.5,104.5,Included in ER Case rate,104.5,104.5, 107.80 ,99
30100543,EAP,CPT  80197,,0301,HC DRUG SCREEN QUANTITATIVE TACROLIMUS #,1,115, 109.25 ,112.7, 109.25 , 111.55 , 109.25 ,Current Medicare Rates,111.55,110.4,109.25,109.25,Included in ER Case rate,109.25,109.25, 112.70 ,103.5
30100544,EAP,CPT  80202,,0301,HC DRUG SCREEN QUANTITATIVE VANCOMYCIN #,1,186.00, 176.70 ,182.28, 176.70 , 180.42 , 176.70 ,Current Medicare Rates,180.42,178.56,176.7,176.7,Included in ER Case rate,176.7,176.7, 182.28 ,167.4
30100547,EAP,CPT  80307,,0301,HC DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE #,1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,264.1,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30100562,EAP,CPT  82040,,0301,HC ALBUMIN SERUM PLASMA/WHOLE BLOOD #,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,57,57,Included in ER Case rate,57,57, 58.80 ,54
30100563,EAP,CPT  82042,,0301,HC OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN #,1,21, 19.95 ,20.58, 19.95 , 20.37 , 19.95 ,Current Medicare Rates,20.37,20.16,19.95,19.95,Included in ER Case rate,19.95,19.95, 20.58 ,18.9
30100564,EAP,CPT  82043,,0301,HC URINE ALBUMIN QUANTITATIVE #,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,114,114,Included in ER Case rate,114,114, 117.60 ,108
30100565,EAP,CPT  82105,,0301,HC ALPHA-FETOPROTEIN SERUM #,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30100567,EAP,CPT  82150,,0301,HC ASSAY OF AMYLASE #,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,95.95,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30100570,EAP,CPT  82247,,0301,HC BILIRUBIN TOTAL #,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,87.4,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30100572,EAP,CPT  82248,,0301,HC BILIRUBIN DIRECT #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30100574,EAP,CPT  82310,,0301,HC CALCIUM TOTAL #,1,67, 63.65 ,65.66, 63.65 , 64.99 , 63.65 ,Current Medicare Rates,64.99,64.32,63.65,63.65,Included in ER Case rate,63.65,63.65, 65.66 ,60.3
30100578,EAP,CPT  82523,,0301,HC COLLAGEN CROSS LINKS ANY METHOD #,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30100580,EAP,CPT  82533,,0301,HC CORTISOL TOTAL #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,95,95,Included in ER Case rate,95,95, 98.00 ,90
30100585,EAP,CPT  82550,,0301,HC CREATINE KINASE TOTAL #,1,99, 94.05 ,97.02, 94.05 , 96.03 , 94.05 ,Current Medicare Rates,96.03,95.04,94.05,94.05,Included in ER Case rate,94.05,94.05, 97.02 ,89.1
30100587,EAP,CPT  82553,,0301,HC CREATINE KINASE MB FRACTION ONLY #,1,159, 151.05 ,155.82, 151.05 , 154.23 , 151.05 ,Current Medicare Rates,154.23,152.64,151.05,151.05,Included in ER Case rate,151.05,151.05, 155.82 ,143.1
30100592,EAP,CPT  82570,,0301,HC CREATININE OTHER SOURCE #,1,80, 76.00 ,78.4, 76.00 , 77.60 , 76.00 ,Current Medicare Rates,77.6,76.8,76,76,Included in ER Case rate,76,76, 78.40 ,72
30100596,EAP,CPT  82670,,0301,HC ASSAY OF ESTRADIOL #,1,200, 190.00 ,196, 190.00 , 194.00 , 190.00 ,Current Medicare Rates,194,192,190,190,Included in ER Case rate,190,190, 196.00 ,180
30100598,EAP,CPT  82677,,0301,HC ASSAY OF ESTRIOL #,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,72.2,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30100606,EAP,CPT  82784,,0301,HC ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH #,1,46, 43.70 ,45.08, 43.70 , 44.62 , 43.70 ,Current Medicare Rates,44.62,44.16,43.7,43.7,Included in ER Case rate,43.7,43.7, 45.08 ,41.4
30100609,EAP,CPT  82785,,0301,HC ASSAY OF GAMMAGLOBULIN IGE #,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,51.3,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30100616,EAP,CPT  82950,,0301,HC GLUCOSE POST GLUCOSE DOSE #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30100617,EAP,CPT  83013,,0301,HC HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE #,1,302, 286.90 ,295.96, 286.90 , 292.94 , 286.90 ,Current Medicare Rates,292.94,289.92,286.9,286.9,Included in ER Case rate,286.9,286.9, 295.96 ,271.8
30100624,EAP,CPT  83655,,0301,HC ASSAY OF LEAD #,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,47.5,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
30100626,EAP,CPT  83690,,0301,HC ASSAY OF LIPASE #,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,111.15,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
30100627,EAP,CPT  83704,,0301,HC LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES #,1,92, 87.40 ,90.16, 87.40 , 89.24 , 87.40 ,Current Medicare Rates,89.24,88.32,87.4,87.4,Included in ER Case rate,87.4,87.4, 90.16 ,82.8
30100630,EAP,CPT  83880,,0301,HC NATRIURETIC PEPTIDE #,1,254, 241.30 ,248.92, 241.30 , 246.38 , 241.30 ,Current Medicare Rates,246.38,243.84,241.3,241.3,Included in ER Case rate,241.3,241.3, 248.92 ,228.6
30100632,EAP,CPT  84075,,0301,HC ASSAY OF PHOSPHATASE ALKALINE #,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,67.45,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30100633,EAP,CPT  84080,,0301,HC ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES #,1,59, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,56.05,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30100635,EAP,CPT  84133,,0301,HC POTASSIUM URINE #,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,67.45,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30100636,EAP,CPT  84155,,0301,HC PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD #,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,93.1,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30100639,EAP,CPT  84156,,0301,HC PROTEIN TOTAL XCPT REFRACTOMETRY URINE #,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,93.1,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30100642,EAP,CPT  84163,,0301,HC PREGNANCY-ASSOCIATED PLASMA PROTEIN-A #,1,107, 101.65 ,104.86, 101.65 , 103.79 , 101.65 ,Current Medicare Rates,103.79,102.72,101.65,101.65,Included in ER Case rate,101.65,101.65, 104.86 ,96.3
30100645,EAP,CPT  84165,,0301,HC PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM #,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,51.3,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
30100651,EAP,CPT  84270,,0301,HC ASSAY OF SEX HORMONE BINDING GLOBULIN #,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,93.1,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30100652,EAP,CPT  84300,,0301,HC ASSAY OF URINE SODIUM #,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,64.6,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30100653,EAP,CPT  84402,,0301,HC ASSAY OF TESTOSTERONE FREE #,1,39, 37.05 ,38.22, 37.05 , 37.83 , 37.05 ,Current Medicare Rates,37.83,37.44,37.05,37.05,Included in ER Case rate,37.05,37.05, 38.22 ,35.1
30100655,EAP,CPT  84403,,0301,HC ASSAY OF TESTOSTERONE TOTAL #,1,255, 242.25 ,249.9, 242.25 , 247.35 , 242.25 ,Current Medicare Rates,247.35,244.8,242.25,242.25,Included in ER Case rate,242.25,242.25, 249.90 ,229.5
30100658,EAP,CPT  84436,,0301,HC ASSAY OF THYROXINE TOTAL #,1,91, 86.45 ,89.18, 86.45 , 88.27 , 86.45 ,Current Medicare Rates,88.27,87.36,86.45,86.45,Included in ER Case rate,86.45,86.45, 89.18 ,81.9
30100659,EAP,CPT  84439,,0301,HC ASSAY OF FREE THYROXINE #,1,98, 93.10 ,96.04, 93.10 , 95.06 , 93.10 ,Current Medicare Rates,95.06,94.08,93.1,93.1,Included in ER Case rate,93.1,93.1, 96.04 ,88.2
30100660,EAP,CPT  84443,,0301,HC ASSAY OF THYROID STIMULATING HORMONE TSH #,1,118, 112.10 ,115.64, 112.10 , 114.46 , 112.10 ,Current Medicare Rates,114.46,113.28,112.1,112.1,Included in ER Case rate,112.1,112.1, 115.64 ,106.2
30100663,EAP,CPT  84479,,0301,HC THYROID HORM UPTK/THYROID HORMONE BINDING RATIO #,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,80.75,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100665,EAP,CPT  84480,,0301,HC ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 #,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,100.7,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
30100666,EAP,CPT  84484,,0301,HC ASSAY OF TROPONIN QUANTITATIVE #,1,151, 143.45 ,147.98, 143.45 , 146.47 , 143.45 ,Current Medicare Rates,146.47,144.96,143.45,143.45,Included in ER Case rate,143.45,143.45, 147.98 ,135.9
30100667,EAP,CPT  84520,,0301,HC ASSAY OF UREA NITROGEN QUANTITATIVE #,1,102, 96.90 ,99.96, 96.90 , 98.94 , 96.90 ,Current Medicare Rates,98.94,97.92,96.9,96.9,Included in ER Case rate,96.9,96.9, 99.96 ,91.8
30100668,EAP,CPT  84550,,0301,HC ASSAY OF BLOOD/URIC ACID #,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,67.45,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30100670,EAP,CPT  84702,,0301,HC GONADOTROPIN CHORIONIC QUANTITATIVE #,1,179, 170.05 ,175.42, 170.05 , 173.63 , 170.05 ,Current Medicare Rates,173.63,171.84,170.05,170.05,Included in ER Case rate,170.05,170.05, 175.42 ,161.1
30100759,EAP,CPT  82397,,0301,HC CHEMILUMINESCENT ASSAY #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30100761,EAP,CPT  82436,,0301,HC CHLORIDE URINE #,1,68, 64.60 ,66.64, 64.60 , 65.96 , 64.60 ,Current Medicare Rates,65.96,65.28,64.6,64.6,Included in ER Case rate,64.6,64.6, 66.64 ,61.2
30100765,EAP,CPT  82945,,0301,HC GLUCOSE BODY FLUID OTHER THAN BLOOD #,1,78, 74.10 ,76.44, 74.10 , 75.66 , 74.10 ,Current Medicare Rates,75.66,74.88,74.1,74.1,Included in ER Case rate,74.1,74.1, 76.44 ,70.2
30100770,EAP,CPT  84154,,0301,HC ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE #,1,85, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,80.75,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30100771,EAP,CPT  84478,,0301,HC ASSAY OF TRIGLYCERIDES #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30100772,EAP,CPT  84630,,0301,HC ASSAY OF ZINC #,1,76, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,72.2,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30100776,EAP,CPT  80186,,0301,HC DRUG SCREEN QUANTITATIVE PHENYTOIN FREE #,1,37, 35.15 ,36.26, 35.15 , 35.89 , 35.15 ,Current Medicare Rates,35.89,35.52,35.15,35.15,Included in ER Case rate,35.15,35.15, 36.26 ,33.3
30100855,EAP,CPT  80061,,0301,HC LIPID PANEL #,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,114,114,Included in ER Case rate,114,114, 117.60 ,108
30110219,EAP,CPT  81596,,0301,HC NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR,1,239, 227.05 ,234.22, 227.05 , 231.83 , 227.05 ,Current Medicare Rates,231.83,229.44,227.05,227.05,Included in ER Case rate,227.05,227.05, 234.22 ,215.1
30112093,EAP,CPT  80195,,0301,HC ASSAY OF SIROLIMUS,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,57,57,Included in ER Case rate,57,57, 58.80 ,54
30112712,EAP,CPT  82985,,0301,HC GLYCATED PROTEIN FRUCTOSAMINE,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,54.15,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30200295,EAP,CPT  86364,,0302,HC TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS #,1,35, 33.25 ,34.3, 33.25 , 33.95 , 33.25 ,Current Medicare Rates,33.95,33.6,33.25,33.25,Included in ER Case rate,33.25,33.25, 34.30 ,31.5
30200304,EAP,CPT  86051,,0302,HC AQUAPORIN-4 ANTIBODY ELISA #,1,35, 33.25 ,34.3, 33.25 , 33.95 , 33.25 ,Current Medicare Rates,33.95,33.6,33.25,33.25,Included in ER Case rate,33.25,33.25, 34.30 ,31.5
30200319,EAP,CPT  86362,,0302,HC MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH #,1,36, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,34.2,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30200496,EAP,CPT  86003,,0302,HC ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH #,1,22, 20.90 ,21.56, 20.90 , 21.34 , 20.90 ,Current Medicare Rates,21.34,21.12,20.9,20.9,Included in ER Case rate,20.9,20.9, 21.56 ,19.8
30200499,EAP,CPT  86038,,0302,HC ANTINUCLEAR ANTIBODIES ANA #,1,57, 54.15 ,55.86, 54.15 , 55.29 , 54.15 ,Current Medicare Rates,55.29,54.72,54.15,54.15,Included in ER Case rate,54.15,54.15, 55.86 ,51.3
30200504,EAP,CPT  86140,,0302,HC C-REACTIVE PROTEIN #,1,27, 25.65 ,26.46, 25.65 , 26.19 , 25.65 ,Current Medicare Rates,26.19,25.92,25.65,25.65,Included in ER Case rate,25.65,25.65, 26.46 ,24.3
30200506,EAP,CPT  86146,,0302,HC BETA 2 GLYCOPROTEIN I ANTIBODY EACH #,1,86, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,81.7,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
30200514,EAP,CPT  86160,,0302,HC COMPLEMENT ANTIGEN EACH COMPONENT #,1,55, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,52.25,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30200517,EAP,CPT  86225,,0302,HC DNA ANTIBODY NATIVE/DOUBLE STRANDED #,1,18, 17.10 ,17.64, 17.10 , 17.46 , 17.10 ,Current Medicare Rates,17.46,17.28,17.1,17.1,Included in ER Case rate,17.1,17.1, 17.64 ,16.2
30200519,EAP,CPT  86235,,0302,HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD #,1,18, 17.10 ,17.64, 17.10 , 17.46 , 17.10 ,Current Medicare Rates,17.46,17.28,17.1,17.1,Included in ER Case rate,17.1,17.1, 17.64 ,16.2
30200526,EAP,CPT  86334,,0302,HC IMMUNOFIXJ ELECTROPHORESIS SERUM #,1,74.00, 70.30 ,72.52, 70.30 , 71.78 , 70.30 ,Current Medicare Rates,71.78,71.04,70.3,70.3,Included in ER Case rate,70.3,70.3, 72.52 ,66.6
30200532,EAP,CPT  86336,,0302,HC INHIBIN A #,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30200534,EAP,CPT  86341,,0302,HC ISLET CELL ANTIBODY #,1,100, 95.00 ,98, 95.00 , 97.00 , 95.00 ,Current Medicare Rates,97,96,95,95,Included in ER Case rate,95,95, 98.00 ,90
30200535,EAP,CPT  86360,,0302,HC T CELLS ABSOLUTE CD4&CD8 COUNT RATIO #,1,75.00, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30200536,EAP,CPT  86376,,0302,HC MICROSOMAL ANTIBODIES EACH #,1,69.00, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,65.55,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
30200537,EAP,CPT  86431,,0302,HC RHEUMATOID FACTOR QUANTITATIVE #,1,24, 22.80 ,23.52, 22.80 , 23.28 , 22.80 ,Current Medicare Rates,23.28,23.04,22.8,22.8,Included in ER Case rate,22.8,22.8, 23.52 ,21.6
30200540,EAP,CPT  86480,,0302,HC TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON #,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,155.8,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
30200543,EAP,CPT  86592,,0302,HC SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL #,1,63, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,59.85,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
30200545,EAP,CPT  86606,,0302,HC ANTIBODY ASPERGILLUS #,1,36.00, 34.20 ,35.28, 34.20 , 34.92 , 34.20 ,Current Medicare Rates,34.92,34.56,34.2,34.2,Included in ER Case rate,34.2,34.2, 35.28 ,32.4
30200547,EAP,CPT  86671,,0302,HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED #,1,71.00, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,67.45,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30200550,EAP,CPT  86692,,0302,HC ANTIBODY HEP DELTA AGENT #,1,71, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,67.45,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30200551,EAP,CPT  86695,,0302,HC ANTIBODY HERPES SMPLX TYPE 1 #,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,57,57,Included in ER Case rate,57,57, 58.80 ,54
30200554,EAP,CPT  86704,,0302,HC HEPATITIS B CORE ANTIBODY HBCAB TOTAL #,1,55.00, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,52.25,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30200556,EAP,CPT  86753,,0302,HC ANTIBODY PROTOZOA NES #,1,70.00, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,66.5,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30200557,EAP,CPT  86757,,0302,HC ANTIBODY RICKETTSIA #,1,55.00, 52.25 ,53.9, 52.25 , 53.35 , 52.25 ,Current Medicare Rates,53.35,52.8,52.25,52.25,Included in ER Case rate,52.25,52.25, 53.90 ,49.5
30200558,EAP,CPT  86780,,0302,HC ANTIBODY TREPONEMA PALLIDUM #,1,49, 46.55 ,48.02, 46.55 , 47.53 , 46.55 ,Current Medicare Rates,47.53,47.04,46.55,46.55,Included in ER Case rate,46.55,46.55, 48.02 ,44.1
30200562,EAP,CPT  86800,,0302,HC THYROGLOBULIN ANTIBODY #,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30200566,EAP,CPT  86901,,0302,HC BLOOD TYPING SEROLOGIC RH (D) #,1,105, 99.75 ,102.9, 99.75 , 101.85 , 99.75 ,Current Medicare Rates,101.85,100.8,99.75,99.75,Included in ER Case rate,99.75,99.75, 102.90 ,94.5
30200655,EAP,CPT  86335,,0302,HC IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS #,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,40.85,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
30200668,EAP,CPT  86355,,0302,HC B CELLS TOTAL COUNT #,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,95.95,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30200670,EAP,CPT  86359,,0302,HC T CELLS TOTAL COUNT #,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,100.7,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
30200671,EAP,CPT  86357,,0302,HC NATURAL KILLER CELLS TOTAL COUNT #,1,106, 100.70 ,103.88, 100.70 , 102.82 , 100.70 ,Current Medicare Rates,102.82,101.76,100.7,100.7,Included in ER Case rate,100.7,100.7, 103.88 ,95.4
30200681,EAP,CPT  86705,,0302,HC HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY #,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
30200682,EAP,CPT  86706,,0302,HC HEPATITIS B SURF ANTIBODY HBSAB #,1,113.00, 107.35 ,110.74, 107.35 , 109.61 , 107.35 ,Current Medicare Rates,109.61,108.48,107.35,107.35,Included in ER Case rate,107.35,107.35, 110.74 ,101.7
30200683,EAP,CPT  86803,,0302,HC HEPATITIS C ANTIBODY #,1,85.00, 80.75 ,83.3, 80.75 , 82.45 , 80.75 ,Current Medicare Rates,82.45,81.6,80.75,80.75,Included in ER Case rate,80.75,80.75, 83.30 ,76.5
30200687,EAP,CPT  86708,,0302,HC HEPATITIS A ANTIBODY HAAB #,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,61.75,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
30200773,EAP,CPT  86635,,0302,HC ANTIBODY COCCIDIOIDES #,1,72.00, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,68.4,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
30500136,EAP,CPT  85014,,0305,HC BLOOD COUNT HEMATOCRIT #,1,45.00, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,42.75,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
30500138,EAP,CPT  85018,,0305,HC BLOOD COUNT HEMOGLOBIN #,1,45.00, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,42.75,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
30500141,EAP,CPT  85025,,0305,HC BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC #,1,86.00, 81.70 ,84.28, 81.70 , 83.42 , 81.70 ,Current Medicare Rates,83.42,82.56,81.7,81.7,Included in ER Case rate,81.7,81.7, 84.28 ,77.4
30500144,EAP,CPT  85027,,0305,HC BLOOD COUNT COMPLETE AUTOMATED #,1,88.00, 83.60 ,86.24, 83.60 , 85.36 , 83.60 ,Current Medicare Rates,85.36,84.48,83.6,83.6,Included in ER Case rate,83.6,83.6, 86.24 ,79.2
30500148,EAP,CPT  85049,,0305,HC BLOOD COUNT PLATELET AUTOMATED #,1,59.00, 56.05 ,57.82, 56.05 , 57.23 , 56.05 ,Current Medicare Rates,57.23,56.64,56.05,56.05,Included in ER Case rate,56.05,56.05, 57.82 ,53.1
30500168,EAP,CPT  85730,,0305,HC THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD #,1,96, 91.20 ,94.08, 91.20 , 93.12 , 91.20 ,Current Medicare Rates,93.12,92.16,91.2,91.2,Included in ER Case rate,91.2,91.2, 94.08 ,86.4
30500214,EAP,CPT  85610,,0301,HC PROTHROMBIN TIME #,1,71.00, 67.45 ,69.58, 67.45 , 68.87 , 67.45 ,Current Medicare Rates,68.87,68.16,67.45,67.45,Included in ER Case rate,67.45,67.45, 69.58 ,63.9
30510003,EAP,CPT  85732,,0305,HC THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA #,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
30510042,EAP,CPT  85660,,0305,HC RBC SICKLE CELL TEST,1,32, 30.40 ,31.36, 30.40 , 31.04 , 30.40 ,Current Medicare Rates,31.04,30.72,30.4,30.4,Included in ER Case rate,30.4,30.4, 31.36 ,28.8
30510454,EAP,CPT  85525,,0305,HC HEPARIN NEUTRALIZATION #,1,38, 36.10 ,37.24, 36.10 , 36.86 , 36.10 ,Current Medicare Rates,36.86,36.48,36.1,36.1,Included in ER Case rate,36.1,36.1, 37.24 ,34.2
30510455,EAP,CPT  85597,,0305,HC PHOSPHOLIPID NEUTRALIZATION PLATELET #,1,60, 57.00 ,58.8, 57.00 , 58.20 , 57.00 ,Current Medicare Rates,58.2,57.6,57,57,Included in ER Case rate,57,57, 58.80 ,54
30510458,EAP,CPT  85635,,0305,HC REPTILASE TEST #,1,31, 29.45 ,30.38, 29.45 , 30.07 , 29.45 ,Current Medicare Rates,30.07,29.76,29.45,29.45,Included in ER Case rate,29.45,29.45, 30.38 ,27.9
30600362,EAP,CPT  87070,,0306,HC CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL #,1,164, 155.80 ,160.72, 155.80 , 159.08 , 155.80 ,Current Medicare Rates,159.08,157.44,155.8,155.8,Included in ER Case rate,155.8,155.8, 160.72 ,147.6
30600369,EAP,CPT  87081,,0306,HC CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ #,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,73.15,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30600372,EAP,CPT  87086,,0306,HC CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE #,1,101, 95.95 ,98.98, 95.95 , 97.97 , 95.95 ,Current Medicare Rates,97.97,96.96,95.95,95.95,Included in ER Case rate,95.95,95.95, 98.98 ,90.9
30600373,EAP,CPT  87116,,0306,HC CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL #,1,51, 48.45 ,49.98, 48.45 , 49.47 , 48.45 ,Current Medicare Rates,49.47,48.96,48.45,48.45,Included in ER Case rate,48.45,48.45, 49.98 ,45.9
30600378,EAP,CPT  87206,,0306,HC SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT #,1,26, 24.70 ,25.48, 24.70 , 25.22 , 24.70 ,Current Medicare Rates,25.22,24.96,24.7,24.7,Included in ER Case rate,24.7,24.7, 25.48 ,23.4
30600384,EAP,CPT  87480,,0306,HC IADNA CANDIDA SPECIES DIRECT PROBE TQ #,1,70.00, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,66.5,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30600386,EAP,CPT  87510,,0306,HC IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ #,1,70, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,66.5,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30600388,EAP,CPT  87522,,0306,HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION #,1,315, 299.25 ,308.7, 299.25 , 305.55 , 299.25 ,Current Medicare Rates,305.55,302.4,299.25,299.25,Included in ER Case rate,299.25,299.25, 308.70 ,283.5
30600390,EAP,CPT  87529,,0306,HC IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ #,1,204, 193.80 ,199.92, 193.80 , 197.88 , 193.80 ,Current Medicare Rates,197.88,195.84,193.8,193.8,Included in ER Case rate,193.8,193.8, 199.92 ,183.6
30600391,EAP,CPT  87536,,0306,HC IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION #,1,278.00, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,264.1,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
30600398,EAP,CPT  87660,,0306,HC IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ #,1,70.00, 66.50 ,68.6, 66.50 , 67.90 , 66.50 ,Current Medicare Rates,67.9,67.2,66.5,66.5,Included in ER Case rate,66.5,66.5, 68.60 ,63
30600400,EAP,CPT  87661,,0306,HC IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH #,1,160.00, 152.00 ,156.8, 152.00 , 155.20 , 152.00 ,Current Medicare Rates,155.2,153.6,152,152,Included in ER Case rate,152,152, 156.80 ,144
30600407,EAP,CPT  87900,,0306,HC NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION #,1,411.00, 390.45 ,402.78, 390.45 , 398.67 , 390.45 ,Current Medicare Rates,398.67,394.56,390.45,390.45,Included in ER Case rate,390.45,390.45, 402.78 ,369.9
30600408,EAP,CPT  87901,,0306,HC NFCT GEXYP NUCLEIC ACID HIV REV TRNSCR&PROTEAS #,1,977.00, 928.15 ,957.46, 928.15 , 947.69 , 928.15 ,Current Medicare Rates,947.69,937.92,928.15,928.15,Included in ER Case rate,928.15,928.15, 957.46 ,879.3
30600418,EAP,CPT  87902,,0306,HC NFCT AGNT GENOTYP NUCLEIC ACID HEPATITIS C VIRUS #,1,650.00, 617.50 ,637, 617.50 , 630.50 , 617.50 ,Current Medicare Rates,630.5,624,617.5,617.5,Included in ER Case rate,617.5,617.5, 637.00 ,585
30600427,EAP,CPT  87491,,0306,HC IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ #,1,76.00, 72.20 ,74.48, 72.20 , 73.72 , 72.20 ,Current Medicare Rates,73.72,72.96,72.2,72.2,Included in ER Case rate,72.2,72.2, 74.48 ,68.4
30600428,EAP,CPT  87591,,0306,HC IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ #,1,77, 73.15 ,75.46, 73.15 , 74.69 , 73.15 ,Current Medicare Rates,74.69,73.92,73.15,73.15,Included in ER Case rate,73.15,73.15, 75.46 ,69.3
30600429,EAP,CPT  87624,,0306,HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES #,1,123, 116.85 ,120.54, 116.85 , 119.31 , 116.85 ,Current Medicare Rates,119.31,118.08,116.85,116.85,Included in ER Case rate,116.85,116.85, 120.54 ,110.7
30600431,EAP,CPT  87340,,0306,HC IAAD IA HEPATITIS B SURFACE ANTIGEN #,1,43, 40.85 ,42.14, 40.85 , 41.71 , 40.85 ,Current Medicare Rates,41.71,41.28,40.85,40.85,Included in ER Case rate,40.85,40.85, 42.14 ,38.7
30610058,EAP,CPT  87481,,0306,HC IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ #,1,117, 111.15 ,114.66, 111.15 , 113.49 , 111.15 ,Current Medicare Rates,113.49,112.32,111.15,111.15,Included in ER Case rate,111.15,111.15, 114.66 ,105.3
30610271,EAP,CPT  87254,,0306,HC VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,61.75,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
31000098,EAP,CPT  81513,,0310,HC NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG #,1,450, 427.50 ,441, 427.50 , 436.50 , 427.50 ,Current Medicare Rates,436.5,432,427.5,427.5,Included in ER Case rate,427.5,427.5, 441.00 ,405
31000203,EAP,CPT  81240,,0310,HC F2 GENE ANALYSIS 20210G >A VARIANT #,1,341, 323.95 ,334.18, 323.95 , 330.77 , 323.95 ,Current Medicare Rates,330.77,327.36,323.95,323.95,Included in ER Case rate,323.95,323.95, 334.18 ,306.9
31000205,EAP,CPT  81331,,0310,HC SNRPN/UBE3A METHYLATION ANALYSIS #,1,188, 178.60 ,184.24, 178.60 , 182.36 , 178.60 ,Current Medicare Rates,182.36,180.48,178.6,178.6,Included in ER Case rate,178.6,178.6, 184.24 ,169.2
31010170,EAP,CPT  81364,,0310,HC HBB FULL GENE SEQUENCE,1,974, 925.30 ,954.52, 925.30 , 944.78 , 925.30 ,Current Medicare Rates,944.78,935.04,925.3,925.3,Included in ER Case rate,925.3,925.3, 954.52 ,876.6
31010655,EAP,CPT  81435,,0310,HC HEREDITARY COLON CANCER MUST INCLUDE 7 GENES,1,1935," 1,838.25 ",1896.3," 1,838.25 "," 1,876.95 "," 1,838.25 ",Current Medicare Rates,1876.95,1857.6,1838.25,1838.25,Included in ER Case rate,1838.25,1838.25," 1,896.30 ",1741.5
31010656,EAP,CPT  81436,,0310,HC HEREDITARY COLON CA SYND MUST INCLUDE 8 GENES,1,1935," 1,838.25 ",1896.3," 1,838.25 "," 1,876.95 "," 1,838.25 ",Current Medicare Rates,1876.95,1857.6,1838.25,1838.25,Included in ER Case rate,1838.25,1838.25," 1,896.30 ",1741.5
31100048,EAP,CPT  88175,,0311,HC CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS #,1,45, 42.75 ,44.1, 42.75 , 43.65 , 42.75 ,Current Medicare Rates,43.65,43.2,42.75,42.75,Included in ER Case rate,42.75,42.75, 44.10 ,40.5
32010135,EAP,CPT  74021,,0320,HC XR EXAM ABDOMEN 3+ VIEWS,1,435, 413.25 ,426.3, 413.25 , 421.95 , 413.25 ,Current Medicare Rates,421.95,417.6,413.25,413.25,Included in ER Case rate,413.25,413.25, 426.30 ,391.5
35210037,EAP,CPT  73206,,0352,HC CT ANGIO UPR EXTRM W/O&W/DYE,1,2600," 2,470.00 ",2548," 2,470.00 "," 2,522.00 "," 2,470.00 ",Current Medicare Rates,2522,2496,2470,2470,Included in ER Case rate,2470,2470," 2,548.00 ",2340
36010152,EAP,Custom   36010152,,0360,HC OPERATING ROOM SERVICES LEVEL 7 1ST 30 MINS,1,5550," 5,272.50 ",5439," 5,272.50 "," 5,383.50 "," 5,272.50 ",Current Medicare Rates,5383.5,5328,5272.5,5272.5,Included in ER Case rate,5272.5,5272.5," 5,439.00 ",4995
36010223,EAP,Custom   36010223,,0360,HC OPERATING ROOM SERVICES LEVEL 7 ADD'L 15 MIN,1,1450," 1,377.50 ",1421," 1,377.50 "," 1,406.50 "," 1,377.50 ",Current Medicare Rates,1406.5,1392,1377.5,1377.5,Included in ER Case rate,1377.5,1377.5," 1,421.00 ",1305
36110602,EAP,CPT  10160,,0361,HC PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST,1,264, 250.80 ,258.72, 250.80 , 256.08 , 250.80 ,Current Medicare Rates,256.08,253.44,250.8,250.8,Included in ER Case rate,250.8,250.8, 258.72 ,237.6
42010010,EAP,CPT  97130,,0420,HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES CDM,1,161, 152.95 ,157.78, 152.95 , 156.17 , 152.95 ,Current Medicare Rates,156.17,154.56,152.95,152.95,Included in ER Case rate,152.95,152.95, 157.78 ,144.9
42010011,EAP,CPT  97129,,0420,HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES CDM,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,61.75,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
44010016,EAP,CPT  92507,,0440,HC SPEECH/HEARING THERAPY - INDIV,1,339, 322.05 ,332.22, 322.05 , 328.83 , 322.05 ,Current Medicare Rates,328.83,325.44,322.05,322.05,Included in ER Case rate,322.05,322.05, 332.22 ,305.1
44010062,EAP,CPT  92609,,0440,HC USE OF SPEECH DEVICE SERVICE,1,401, 380.95 ,392.98, 380.95 , 388.97 , 380.95 ,Current Medicare Rates,388.97,384.96,380.95,380.95,Included in ER Case rate,380.95,380.95, 392.98 ,360.9
44010083,EAP,CPT  96125,,0444,HC COGNITIVE TEST BY HC PRO PER HOUR,1,389, 369.55 ,381.22, 369.55 , 377.33 , 369.55 ,Current Medicare Rates,377.33,373.44,369.55,369.55,Included in ER Case rate,369.55,369.55, 381.22 ,350.1
45010024,EAP,CPT  30020,,0450,HC ED DRAINAGE OF NASAL SEPTUM ABSCESS/HEMATOMA CDM,1,291, 276.45 ,285.18, 276.45 , 282.27 , 276.45 ,Current Medicare Rates,282.27,279.36,276.45,276.45,Included in ER Case rate,276.45,276.45, 285.18 ,261.9
45010092,EAP,CPT  43761,,0450,HC ED REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO CDM,1,278, 264.10 ,272.44, 264.10 , 269.66 , 264.10 ,Current Medicare Rates,269.66,266.88,264.1,264.1,Included in ER Case rate,264.1,264.1, 272.44 ,250.2
45010229,EAP,CPT  51798,,0450,HC ED MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP CDM,1,188, 178.60 ,184.24, 178.60 , 182.36 , 178.60 ,Current Medicare Rates,182.36,180.48,178.6,178.6,Included in ER Case rate,178.6,178.6, 184.24 ,169.2
45010930,EAP,CPT  96361,,0450,HC ED IV INFUSION HYDRATION EACH ADDITIONAL HOUR CDM,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,114,114,Included in ER Case rate,114,114, 117.60 ,108
45011001,EAP,CPT  96360,,0450,HC ED IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR CDM,1,330, 313.50 ,323.4, 313.50 , 320.10 , 313.50 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,313.5, 323.40 ,297
45011002,EAP,CPT  96367,,0450,HC ED IV INFUSION THERAPY PROPHYLAXIS ADDL SEQUENTIAL TO 1 HR CDM,1,125, 118.75 ,122.5, 118.75 , 121.25 , 118.75 ,Current Medicare Rates,121.25,120,118.75,118.75,Included in ER Case rate,118.75,118.75, 122.50 ,112.5
45011003,EAP,CPT  96366,,0450,HC ED IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR CDM,1,123, 116.85 ,120.54, 116.85 , 119.31 , 116.85 ,Current Medicare Rates,119.31,118.08,116.85,116.85,Included in ER Case rate,116.85,116.85, 120.54 ,110.7
45011004,EAP,CPT  96365,,0450,HC ED IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR CDM,1,330, 313.50 ,323.4, 313.50 , 320.10 , 313.50 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,313.5, 323.40 ,297
45011005,EAP,CPT  96368,,0450,HC ED IV INFUSION THERAPY PROPHYLAXIS/DX CONCURRENT NFS CDM,1,257, 244.15 ,251.86, 244.15 , 249.29 , 244.15 ,Current Medicare Rates,249.29,246.72,244.15,244.15,Included in ER Case rate,244.15,244.15, 251.86 ,231.3
45011010,EAP,CPT  96376,,0450,HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EA SEQL SBST/DRUG FAC CDM,1,122, 115.90 ,119.56, 115.90 , 118.34 , 115.90 ,Current Medicare Rates,118.34,117.12,115.9,115.9,Included in ER Case rate,115.9,115.9, 119.56 ,109.8
45011011,EAP,CPT  96374,,0450,HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH SINGLE/1ST SBST/DRUG CDM,1,205, 194.75 ,200.9, 194.75 , 198.85 , 194.75 ,Current Medicare Rates,198.85,196.8,194.75,194.75,Included in ER Case rate,194.75,194.75, 200.90 ,184.5
45011012,EAP,CPT  96375,,0450,HC ED IV INJECTION THERAPEUTIC PROPH/DX PUSH EACH NEW DRUG CDM,1,114, 108.30 ,111.72, 108.30 , 110.58 , 108.30 ,Current Medicare Rates,110.58,109.44,108.3,108.3,Included in ER Case rate,108.3,108.3, 111.72 ,102.6
45011013,EAP,CPT  96372,,0450,HC ED THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM CDM,1,163, 154.85 ,159.74, 154.85 , 158.11 , 154.85 ,Current Medicare Rates,158.11,156.48,154.85,154.85,Included in ER Case rate,154.85,154.85, 159.74 ,146.7
48310004,EAP,CPT  93356,,0483,HC ECHO MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH CDM,1,105, 99.75 ,102.9, 99.75 , 101.85 , 99.75 ,Current Medicare Rates,101.85,100.8,99.75,99.75,Included in ER Case rate,99.75,99.75, 102.90 ,94.5
52100034,EAP,CPT  98961,,0521,"HC PR 98961 SELF-MGMT EDUC/TRAIN, 2-4 PT, EA 30 MIN RHC",1,30, 28.50 ,29.4, 28.50 , 29.10 , 28.50 ,Current Medicare Rates,29.1,28.8,28.5,28.5,Included in ER Case rate,28.5,28.5, 29.40 ,27
52100035,EAP,CPT  98962,,0521,"HC PR 98962 SELF-MGMT EDUC/TRAIN, 5-8 PT, EA 30 MIN RHC",1,23, 21.85 ,22.54, 21.85 , 22.31 , 21.85 ,Current Medicare Rates,22.31,22.08,21.85,21.85,Included in ER Case rate,21.85,21.85, 22.54 ,20.7
52100099,EAP,CPT  G2212,,0521,HC PR G2212 PROLONG OUTPT/OFFICE VIS RHC,1,72, 68.40 ,70.56, 68.40 , 69.84 , 68.40 ,Current Medicare Rates,69.84,69.12,68.4,68.4,Included in ER Case rate,68.4,68.4, 70.56 ,64.8
52110008,EAP,HCPCS  G0071,,0521,HC PR G0071 TELEPHONE/EVISIT SVCS BY RHC/FQHC 5 MIN,1,202, 191.90 ,197.96, 191.90 , 195.94 , 191.90 ,Current Medicare Rates,195.94,193.92,191.9,191.9,Included in ER Case rate,191.9,191.9, 197.96 ,181.8
52110013,EAP,CPT  99422,,0521,HC PR 99422 ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES RHC,1,65, 61.75 ,63.7, 61.75 , 63.05 , 61.75 ,Current Medicare Rates,63.05,62.4,61.75,61.75,Included in ER Case rate,61.75,61.75, 63.70 ,58.5
52110044,EAP,CPT  11301,,0521,HC PR 11301 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM RHC,1,277, 263.15 ,271.46, 263.15 , 268.69 , 263.15 ,Current Medicare Rates,268.69,265.92,263.15,263.15,Included in ER Case rate,263.15,263.15, 271.46 ,249.3
52110125,EAP,CPT  12015,,0521,HC PR 12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM RHC,1,387, 367.65 ,379.26, 367.65 , 375.39 , 367.65 ,Current Medicare Rates,375.39,371.52,367.65,367.65,Included in ER Case rate,367.65,367.65, 379.26 ,348.3
52110131,EAP,CPT  12031,,0521,HC PR 12031 REPAIR INTERMEDIATE SCLP/AXL/TRK/EXTM LTE 2.5 CM RHC,1,597, 567.15 ,585.06, 567.15 , 579.09 , 567.15 ,Current Medicare Rates,579.09,573.12,567.15,567.15,Included in ER Case rate,567.15,567.15, 585.06 ,537.3
52110171,EAP,CPT  16020,,0521,HC PR 16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL RHC,1,181, 171.95 ,177.38, 171.95 , 175.57 , 171.95 ,Current Medicare Rates,175.57,173.76,171.95,171.95,Included in ER Case rate,171.95,171.95, 177.38 ,162.9
52110569,EAP,CPT  64405,,0521,HC PR 64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV RHC,1,169, 160.55 ,165.62, 160.55 , 163.93 , 160.55 ,Current Medicare Rates,163.93,162.24,160.55,160.55,Included in ER Case rate,160.55,160.55, 165.62 ,152.1
52110627,EAP,CPT  93351,,0521,HC PR 93351 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG RHC,1,2122," 2,015.90 ",2079.56," 2,015.90 "," 2,058.34 "," 2,015.90 ",Current Medicare Rates,2058.34,2037.12,2015.9,2015.9,Included in ER Case rate,2015.9,2015.9," 2,079.56 ",1909.8
52110658,EAP,CPT  97535,,0521,HC PR 97535 SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES RHC,1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
52110671,EAP,CPT  98960,,0521,HC PR 98960 EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT RHC,1,64, 60.80 ,62.72, 60.80 , 62.08 , 60.80 ,Current Medicare Rates,62.08,61.44,60.8,60.8,Included in ER Case rate,60.8,60.8, 62.72 ,57.6
52110673,EAP,CPT  98967,,0521,HC PR 98967 NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN RHC,1,50, 47.50 ,49, 47.50 , 48.50 , 47.50 ,Current Medicare Rates,48.5,48,47.5,47.5,Included in ER Case rate,47.5,47.5, 49.00 ,45
52110692,EAP,CPT  99242,,0521,HC PR 99242 OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES RHC,1,379, 360.05 ,371.42, 360.05 , 367.63 , 360.05 ,Current Medicare Rates,367.63,363.84,360.05,360.05,Included in ER Case rate,360.05,360.05, 371.42 ,341.1
52110694,EAP,CPT  99244,,0521,HC PR 99244 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES RHC,1,396, 376.20 ,388.08, 376.20 , 384.12 , 376.20 ,Current Medicare Rates,384.12,380.16,376.2,376.2,Included in ER Case rate,376.2,376.2, 388.08 ,356.4
52110704,EAP,CPT  99307,,0524,HC PR 99307 SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES RHC,1,120, 114.00 ,117.6, 114.00 , 116.40 , 114.00 ,Current Medicare Rates,116.4,115.2,114,114,Included in ER Case rate,114,114, 117.60 ,108
52110705,EAP,CPT  99308,,0524,HC PR 99308 SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES RHC,1,185, 175.75 ,181.3, 175.75 , 179.45 , 175.75 ,Current Medicare Rates,179.45,177.6,175.75,175.75,Included in ER Case rate,175.75,175.75, 181.30 ,166.5
52110706,EAP,CPT  99309,,0524,HC PR 99309 SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES RHC,1,246, 233.70 ,241.08, 233.70 , 238.62 , 233.70 ,Current Medicare Rates,238.62,236.16,233.7,233.7,Included in ER Case rate,233.7,233.7, 241.08 ,221.4
52110707,EAP,CPT  99310,,0524,HC PR 99310 SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES RHC,1,319, 303.05 ,312.62, 303.05 , 309.43 , 303.05 ,Current Medicare Rates,309.43,306.24,303.05,303.05,Included in ER Case rate,303.05,303.05, 312.62 ,287.1
52110720,EAP,CPT  99341,,0522,HC PR 99341 HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES RHC,1,239, 227.05 ,234.22, 227.05 , 231.83 , 227.05 ,Current Medicare Rates,231.83,229.44,227.05,227.05,Included in ER Case rate,227.05,227.05, 234.22 ,215.1
52110721,EAP,CPT  99342,,0522,HC PR 99342 HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES RHC,1,379, 360.05 ,371.42, 360.05 , 367.63 , 360.05 ,Current Medicare Rates,367.63,363.84,360.05,360.05,Included in ER Case rate,360.05,360.05, 371.42 ,341.1
52110723,EAP,CPT  99344,,0522,HC PR 99344 HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES RHC,1,538, 511.10 ,527.24, 511.10 , 521.86 , 511.10 ,Current Medicare Rates,521.86,516.48,511.1,511.1,Included in ER Case rate,511.1,511.1, 527.24 ,484.2
52110724,EAP,CPT  99345,,0522,HC PR 99345 HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES RHC,1,770, 731.50 ,754.6, 731.50 , 746.90 , 731.50 ,Current Medicare Rates,746.9,739.2,731.5,731.5,Included in ER Case rate,731.5,731.5, 754.60 ,693
52110725,EAP,CPT  99347,,0522,HC PR 99347 HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES RHC,1,147, 139.65 ,144.06, 139.65 , 142.59 , 139.65 ,Current Medicare Rates,142.59,141.12,139.65,139.65,Included in ER Case rate,139.65,139.65, 144.06 ,132.3
52110726,EAP,CPT  99348,,0522,HC PR 99348 HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES RHC,1,233, 221.35 ,228.34, 221.35 , 226.01 , 221.35 ,Current Medicare Rates,226.01,223.68,221.35,221.35,Included in ER Case rate,221.35,221.35, 228.34 ,209.7
52110727,EAP,CPT  99349,,0522,HC PR 99349 HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES RHC,1,347, 329.65 ,340.06, 329.65 , 336.59 , 329.65 ,Current Medicare Rates,336.59,333.12,329.65,329.65,Included in ER Case rate,329.65,329.65, 340.06 ,312.3
52110745,EAP,CPT  99381,,0521,HC PR 99381 INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR RHC,1,316, 300.20 ,309.68, 300.20 , 306.52 , 300.20 ,Current Medicare Rates,306.52,303.36,300.2,300.2,Included in ER Case rate,300.2,300.2, 309.68 ,284.4
52110746,EAP,CPT  99382,,0521,HC PR 99382 INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS RHC,1,330, 313.50 ,323.4, 313.50 , 320.10 , 313.50 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,313.5, 323.40 ,297
52110747,EAP,CPT  99383,,0521,HC PR 99383 INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS RHC,1,342, 324.90 ,335.16, 324.90 , 331.74 , 324.90 ,Current Medicare Rates,331.74,328.32,324.9,324.9,Included in ER Case rate,324.9,324.9, 335.16 ,307.8
52110748,EAP,CPT  99384,,0521,HC PR 99384 PREVENTIVE VISIT NEW 12-17  RHC,1,387, 367.65 ,379.26, 367.65 , 375.39 , 367.65 ,Current Medicare Rates,375.39,371.52,367.65,367.65,Included in ER Case rate,367.65,367.65, 379.26 ,348.3
52110749,EAP,CPT  99385,,0521,HC PR 99385 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS RHC,1,378, 359.10 ,370.44, 359.10 , 366.66 , 359.10 ,Current Medicare Rates,366.66,362.88,359.1,359.1,Included in ER Case rate,359.1,359.1, 370.44 ,340.2
52110750,EAP,CPT  99386,,0521,HC PR 99386 PREVENTIVE VISIT NEW 40-64  RHC,1,435, 413.25 ,426.3, 413.25 , 421.95 , 413.25 ,Current Medicare Rates,421.95,417.6,413.25,413.25,Included in ER Case rate,413.25,413.25, 426.30 ,391.5
52110751,EAP,CPT  99387,,0521,HC PR 99387 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> RHC,1,449, 426.55 ,440.02, 426.55 , 435.53 , 426.55 ,Current Medicare Rates,435.53,431.04,426.55,426.55,Included in ER Case rate,426.55,426.55, 440.02 ,404.1
52110752,EAP,CPT  99391,,0521,HC PR 99391 PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y RHC,1,284, 269.80 ,278.32, 269.80 , 275.48 , 269.80 ,Current Medicare Rates,275.48,272.64,269.8,269.8,Included in ER Case rate,269.8,269.8, 278.32 ,255.6
52110753,EAP,CPT  99392,,0521,HC PR 99392 PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS RHC,1,302, 286.90 ,295.96, 286.90 , 292.94 , 286.90 ,Current Medicare Rates,292.94,289.92,286.9,286.9,Included in ER Case rate,286.9,286.9, 295.96 ,271.8
52110754,EAP,CPT  99393,,0521,HC PR 99393 PREV VISIT EST AGE 5-11  RHC,1,302, 286.90 ,295.96, 286.90 , 292.94 , 286.90 ,Current Medicare Rates,292.94,289.92,286.9,286.9,Included in ER Case rate,286.9,286.9, 295.96 ,271.8
52110755,EAP,CPT  99394,,0521,HC PR 99394 PREVENTIVE VISIT EST 12-17 RHC,1,330, 313.50 ,323.4, 313.50 , 320.10 , 313.50 ,Current Medicare Rates,320.1,316.8,313.5,313.5,Included in ER Case rate,313.5,313.5, 323.40 ,297
52110756,EAP,CPT  99395,,0521,HC PR 99395 PREVENTIVE VISIT EST 18-39  RHC,1,339, 322.05 ,332.22, 322.05 , 328.83 , 322.05 ,Current Medicare Rates,328.83,325.44,322.05,322.05,Included in ER Case rate,322.05,322.05, 332.22 ,305.1
52110757,EAP,CPT  99396,,0521,HC PR 99396 PREVENTIVE VISIT EST 40-64  RHC,1,362, 343.90 ,354.76, 343.90 , 351.14 , 343.90 ,Current Medicare Rates,351.14,347.52,343.9,343.9,Included in ER Case rate,343.9,343.9, 354.76 ,325.8
52110758,EAP,CPT  99397,,0521,HC PR 99397 PREVENTIVE VISIT EST 65 & OVER RHC,1,389, 369.55 ,381.22, 369.55 , 377.33 , 369.55 ,Current Medicare Rates,377.33,373.44,369.55,369.55,Included in ER Case rate,369.55,369.55, 381.22 ,350.1
52110760,EAP,CPT  99402,,0521,HC PR 99402 PREVENTIVE COUNSELING INDIV 30 MIN RHC,1,143, 135.85 ,140.14, 135.85 , 138.71 , 135.85 ,Current Medicare Rates,138.71,137.28,135.85,135.85,Included in ER Case rate,135.85,135.85, 140.14 ,128.7
52110761,EAP,CPT  99403,,0521,HC PR 99403 PREVENTIVE COUNSELING INDIV 45 MIN RHC,1,194, 184.30 ,190.12, 184.30 , 188.18 , 184.30 ,Current Medicare Rates,188.18,186.24,184.3,184.3,Included in ER Case rate,184.3,184.3, 190.12 ,174.6
52110762,EAP,CPT  99404,,0521,HC PR 99404 PREVENTIVE COUNSELING INDIV 60 MIN RHC,1,250, 237.50 ,245, 237.50 , 242.50 , 237.50 ,Current Medicare Rates,242.5,240,237.5,237.5,Included in ER Case rate,237.5,237.5, 245.00 ,225
52110763,EAP,CPT  99406,,0521,HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN RHC,1,34, 32.30 ,33.32, 32.30 , 32.98 , 32.30 ,Current Medicare Rates,32.98,32.64,32.3,32.3,Included in ER Case rate,32.3,32.3, 33.32 ,30.6
52110764,EAP,CPT  99407,,0521,HC PR 99407 BEHAV CHNG SMOKING > 10 MIN RHC,1,63.00, 59.85 ,61.74, 59.85 , 61.11 , 59.85 ,Current Medicare Rates,61.11,60.48,59.85,59.85,Included in ER Case rate,59.85,59.85, 61.74 ,56.7
52110765,EAP,CPT  99408,,0521,HC PR 99408 ALCOHOL/DRUG SCREEN 15-30 MIN RHC,1,79, 75.05 ,77.42, 75.05 , 76.63 , 75.05 ,Current Medicare Rates,76.63,75.84,75.05,75.05,Included in ER Case rate,75.05,75.05, 77.42 ,71.1
52110766,EAP,CPT  99409,,0521,HC PR 99409 ALCOHOL/DRUG SCREEN > 30 MIN RHC,1,151, 143.45 ,147.98, 143.45 , 146.47 , 143.45 ,Current Medicare Rates,146.47,144.96,143.45,143.45,Included in ER Case rate,143.45,143.45, 147.98 ,135.9
52710001,EAP,HCPCS  G0490,,0527,HC PR G0490 HOME VISIT RN/LPN BY RHC/FQ,1,79, 75.05 ,77.42, 75.05 , 76.63 , 75.05 ,Current Medicare Rates,76.63,75.84,75.05,75.05,Included in ER Case rate,75.05,75.05, 77.42 ,71.1
54010146,EAP,Custom   54010146,,0540,HC CABULANCE PER MILE,1,622, 590.90 ,609.56, 590.90 , 603.34 , 590.90 ,Current Medicare Rates,603.34,597.12,590.9,590.9,Included in ER Case rate,590.9,590.9, 609.56 ,559.8
63610063,EAP,HCPCS  J0585,,0636,HC PR RX ONABOTULINUMTOXINA INJ 1 UNIT,1,15, 14.25 ,14.7, 14.25 , 14.55 , 14.25 ,Current Medicare Rates,14.55,14.4,14.25,14.25,Included in ER Case rate,14.25,14.25, 14.70 ,13.5
63610188,EAP,HCPCS  J7326,,0636,HC PR RX HYALURONAN OR DERIVATIVE (GEL-ONE) INJ 1 EA,1,3043," 2,890.85 ",2982.14," 2,890.85 "," 2,951.71 "," 2,890.85 ",Current Medicare Rates,2951.71,2921.28,2890.85,2890.85,Included in ER Case rate,2890.85,2890.85," 2,982.14 ",2738.7
63610336,EAP,HCPCS  J7323,,0636,HC PR RX HYALURONAN OR DERIVATIVE (EUFLEXXA) INJ 1 EA,1,2647," 2,514.65 ",2594.06," 2,514.65 "," 2,567.59 "," 2,514.65 ",Current Medicare Rates,2567.59,2541.12,2514.65,2514.65,Included in ER Case rate,2514.65,2514.65," 2,594.06 ",2382.3
76110004,EAP,CPT  99204,,0761,HC NEW PT VISIT - LEVEL 4,1,395, 375.25 ,387.1, 375.25 , 383.15 , 375.25 ,Current Medicare Rates,383.15,379.2,375.25,375.25,Included in ER Case rate,375.25,375.25, 387.10 ,355.5
76110551,EAP,CPT  99215,,0761,HC L&D TRIAGE ESTAB PATIENT LVL 5 CDM,1,329, 312.55 ,322.42, 312.55 , 319.13 , 312.55 ,Current Medicare Rates,319.13,315.84,312.55,312.55,Included in ER Case rate,312.55,312.55, 322.42 ,296.1
77100011,EAP,CPT  0051A,,0771,HC COVID 19 IMMUNIZATION PFIZER TRIS SUCROSE 1ST ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100012,EAP,CPT  0052A,,0771,HC COVID 19 IMMUNIZATION PFIZER TRIS SUCROSE 2ND ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100013,EAP,CPT  0053A,,0771,HC COVID 19 IMMUNIZATION PFIZER TRIS SUCROSE 3RD ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,65.55,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100014,EAP,CPT  0054A,,0771,HC COVID 19 IMMUNIZATION PFIZER TRIS SUCROSE BOOSTER ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100019,EAP,CPT  0073A,,0771,HC COVID 19 IMMUNIZATION PFIZER PEDIATRIC 3RD ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,65.55,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100024,EAP,CPT  0111A,,0771,HC COVID 19 IMMUNIZATION MODERNA PEDS 6M - 5Y 1ST ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,65.55,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100025,EAP,CPT  0112A,,0771,HC COVID 19 IMMUNIZATION MODERNA PEDS 6M - 5Y 2ND ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,65.55,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
77100026,EAP,CPT  0081A,,0771,HC COVID 19 IMMUNIZATION PFIZER PEDS 6M - 4Y 1ST ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100027,EAP,CPT  0082A,,0771,HC COVID 19 IMMUNIZATION PFIZER PEDS 6M - 4Y 2ND ADMIN,1,66, 62.70 ,64.68, 62.70 , 64.02 , 62.70 ,Current Medicare Rates,64.02,63.36,62.7,62.7,Included in ER Case rate,62.7,62.7, 64.68 ,59.4
77100028,EAP,CPT  0083A,,0771,HC COVID 19 IMMUNIZATION PFIZER PEDS 6M - 4Y 3RD ADMIN,1,69, 65.55 ,67.62, 65.55 , 66.93 , 65.55 ,Current Medicare Rates,66.93,66.24,65.55,65.55,Included in ER Case rate,65.55,65.55, 67.62 ,62.1
78010001,EAP,HCPCS  Q3014,,0780,HC TELEHEALTH FACILITY FEE Q3014 CDM,1,54, 51.30 ,52.92, 51.30 , 52.38 , 51.30 ,Current Medicare Rates,52.38,51.84,51.3,51.3,Included in ER Case rate,51.3,51.3, 52.92 ,48.6
90000061,EAP,CPT  H0032,,0900,HC MH PLAN NOT MD CDM,1,79, 75.05 ,77.42, 75.05 , 76.63 , 75.05 ,Current Medicare Rates,76.63,75.84,75.05,75.05,Included in ER Case rate,75.05,75.05, 77.42 ,71.1
90010082,EAP,HCPCS  H0033,,0900,HC ORAL MED DIRECT OBSERVATION (PER DAY),1,79, 75.05 ,77.42, 75.05 , 76.63 , 75.05 ,Current Medicare Rates,76.63,75.84,75.05,75.05,Included in ER Case rate,75.05,75.05, 77.42 ,71.1
90410002,EAP,HCPCS  H2014,,0904,HC SKILLS TRAIN & DEVELOP PER 15 MIN,1,79, 75.05 ,77.42, 75.05 , 76.63 , 75.05 ,Current Medicare Rates,76.63,75.84,75.05,75.05,Included in ER Case rate,75.05,75.05, 77.42 ,71.1
91410118,EAP,HCPCS  H2016,,0914,"HC COMP COMM SUPP SVC, PER DIEM",1,75, 71.25 ,73.5, 71.25 , 72.75 , 71.25 ,Current Medicare Rates,72.75,72,71.25,71.25,Included in ER Case rate,71.25,71.25, 73.50 ,67.5
94210113,EAP,HCPCS  G0177,,0942,HC EDUCATION TRAIN 45 MIN OR MORE,1,194, 184.30 ,190.12, 184.30 , 188.18 , 184.30 ,Current Medicare Rates,188.18,186.24,184.3,184.3,Included in ER Case rate,184.3,184.3, 190.12 ,174.6
96310026,EAP,CPT  00350,,0963,HC PR 00350 ANESTH NECK VESSEL SURGERY,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310046,EAP,CPT  00534,,0963,HC PR 00534 ANESTH CARDIOVERTER/DEFIB,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310074,EAP,CPT  00834,,0963,HC PR 00834 ANESTH HERNIA REPAIR < 1 YR,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310114,EAP,CPT  01210,,0963,HC PR 01210 ANESTH HIP JOINT SURGERY,1,9, 8.55 ,8.82, 8.55 , 8.73 , 8.55 ,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55, 8.82 ,8.1
96310168,EAP,CPT  01716,,0963,HC PR 01716 ANESTH BICEPS TENDON REPAIR,1,9,8.55,8.82,8.55,8.73,8.55,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55,8.82,8.1
96310256,EAP,CPT  64445,,0963,HC PR 64445 INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN CDM,1,9,8.55,8.82,8.55,8.73,8.55,Current Medicare Rates,8.73,8.64,8.55,8.55,Included in ER Case rate,8.55,8.55,8.82,8.1
96910007,EAP,CPT  97605,,0983,HC PR 97605 NEG PRESS WOUND TX UTILIZING DME EQUIP < 50SQ CM,1,539,512.05,528.22,512.05,522.83,512.05,Current Medicare Rates,522.83,517.44,512.05,512.05,Included in ER Case rate,512.05,512.05,528.22,485.1
96910019,EAP,CPT  81025,,0983,HC PR 81025 URINE PREGNANCY TEST,1,26,24.7,25.48,24.7,25.22,24.7,Current Medicare Rates,25.22,24.96,24.7,24.7,Included in ER Case rate,24.7,24.7,25.48,23.4
96910020,EAP,CPT  82962,,0983,HC PR 82962 GLUCOSE BLOOD TEST,1,20,19,19.6,19,19.4,19,Current Medicare Rates,19.4,19.2,19,19,Included in ER Case rate,19,19,19.6,18
96910125,EAP,CPT  99350,,0983,HC PR 99350 HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES CDM,1,364,345.8,356.72,345.8,353.08,345.8,Current Medicare Rates,353.08,349.44,345.8,345.8,Included in ER Case rate,345.8,345.8,356.72,327.6
96910173,EAP,CPT  36415,,0983,HC PR 36415 ROUTINE VENIPUNCTURE,1,33,31.35,32.34,31.35,32.01,31.35,Current Medicare Rates,32.01,31.68,31.35,31.35,Included in ER Case rate,31.35,31.35,32.34,29.7
96910185,EAP,CPT  99441,,0983,HC PR 99441 PHONE E/M BY PHYS 5-10 MIN,1,118,112.1,115.64,112.1,114.46,112.1,Current Medicare Rates,114.46,113.28,112.1,112.1,Included in ER Case rate,112.1,112.1,115.64,106.2
96910319,EAP,CPT  76815,,0983,HC PR 76815 US OB LIMITED FETUS(S),1,176,167.2,172.48,167.2,170.72,167.2,Current Medicare Rates,170.72,168.96,167.2,167.2,Included in ER Case rate,167.2,167.2,172.48,158.4
96910452,EAP,CPT  90882,,0983,HC PR 90882 ENVIRONMENTAL MANIPULATION,1,295,280.25,289.1,280.25,286.15,280.25,Current Medicare Rates,286.15,283.2,280.25,280.25,Included in ER Case rate,280.25,280.25,289.1,265.5
96910507,EAP,CPT  17261,,0983,HC PR 17261 DESTRUCTION OF SKIN LESIONS TNK/ARM/LG M 0.6-1,1,331,314.45,324.38,314.45,321.07,314.45,Current Medicare Rates,321.07,317.76,314.45,314.45,Included in ER Case rate,314.45,314.45,324.38,297.9
96910696,EAP,HCPCS  Q4012,,0983,HC PR Q4012 CAST SUP SHT ARM PED FBRGLAS,1,36,34.2,35.28,34.2,34.92,34.2,Current Medicare Rates,34.92,34.56,34.2,34.2,Included in ER Case rate,34.2,34.2,35.28,32.4
96910719,EAP,CPT  25607,,0983,HC PR 25607 TREAT FX RAD EXTRA-ARTICUL,1,1583,1503.85,1551.34,1503.85,1535.51,1503.85,Current Medicare Rates,1535.51,1519.68,1503.85,1503.85,Included in ER Case rate,1503.85,1503.85,1551.34,1424.7
96910735,EAP,CPT  26615,,0983,HC PR 26615 TREAT METACARPAL FRACTURE W/INTERNAL FIXATION,1,1235,1173.25,1210.3,1173.25,1197.95,1173.25,Current Medicare Rates,1197.95,1185.6,1173.25,1173.25,Included in ER Case rate,1173.25,1173.25,1210.3,1111.5
96910775,EAP,CPT  27613,,0983,HC PR 27613 BIOPSY LOWER LEG SOFT TISSUE,1,544,516.8,533.12,516.8,527.68,516.8,Current Medicare Rates,527.68,522.24,516.8,516.8,Included in ER Case rate,516.8,516.8,533.12,489.6
96910780,EAP,CPT  27823,,0983,HC PR 27823 OPEN TREATMENT OF ANKLE FRACTURE W/FIXATION,1,2222,2110.9,2177.56,2110.9,2155.34,2110.9,Current Medicare Rates,2155.34,2133.12,2110.9,2110.9,Included in ER Case rate,2110.9,2110.9,2177.56,1999.8
96910862,EAP,CPT  64721,,0983,HC PR 64721 CARPAL TUNNEL SURGERY,1,952,904.4,932.96,904.4,923.44,904.4,Current Medicare Rates,923.44,913.92,904.4,904.4,Included in ER Case rate,904.4,904.4,932.96,856.8
96910882,EAP,CPT  29870,,0983,HC PR 29870 KNEE ARTHROSCOPY DX,1,1189,1129.55,1165.22,1129.55,1153.33,1129.55,Current Medicare Rates,1153.33,1141.44,1129.55,1129.55,Included in ER Case rate,1129.55,1129.55,1165.22,1070.1
96910904,EAP,HCPCS  Q0144,,0983,HC PR Q0144 AZITHROMYCIN DIHYDRATE ORAL-CAPSULE-POWDER 1 GM,1,4,3.8,3.92,3.8,3.88,3.8,Current Medicare Rates,3.88,3.84,3.8,3.8,Included in ER Case rate,3.8,3.8,3.92,3.6
96911231,EAP,CPT  10035,,0983,HC PR 10035 PERQ DEV SOFT TISS 1ST IMAG,1,819,778.05,802.62,778.05,794.43,778.05,Current Medicare Rates,794.43,786.24,778.05,778.05,Included in ER Case rate,778.05,778.05,802.62,737.1
97210002,EAP,CPT  74300,,0972,HC PR 74300 XR BILE DUCTS/PANCREAS INTRAOP,1,405,384.75,396.9,384.75,392.85,384.75,Current Medicare Rates,392.85,388.8,384.75,384.75,Included in ER Case rate,384.75,384.75,396.9,364.5
97210303,EAP,CPT  19000,,0972,HC PR 19000 DRAINAGE OF BREAST LESION,1,224,212.8,219.52,212.8,217.28,212.8,Current Medicare Rates,217.28,215.04,212.8,212.8,Included in ER Case rate,212.8,212.8,219.52,201.6
97210569,EAP,CPT  71110,,0972,HC PR  71110 X-RAY RIBS 3 VW BILAT,1,314,298.3,307.72,298.3,304.58,298.3,Current Medicare Rates,304.58,301.44,298.3,298.3,Included in ER Case rate,298.3,298.3,307.72,282.6
97500037,EAP,CPT  27818,,0975,HC PR 27818 CLOSED RX TRIMALLEOLAR FX MANIP  CDM,1,1057,1004.15,1035.86,1004.15,1025.29,1004.15,Current Medicare Rates,1025.29,1014.72,1004.15,1004.15,Included in ER Case rate,1004.15,1004.15,1035.86,951.3
97500046,EAP,CPT  25609,,0975,"HC PR 25609 OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 3+ FRAG [25609] CDM",1,2179,2070.05,2135.42,2070.05,2113.63,2070.05,Current Medicare Rates,2113.63,2091.84,2070.05,2070.05,Included in ER Case rate,2070.05,2070.05,2135.42,1961.1
97500052,EAP,CPT  45398,,0975,HC PR 45398 COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) [45398] CDM,1,1853,1760.35,1815.94,1760.35,1797.41,1760.35,Current Medicare Rates,1797.41,1778.88,1760.35,1760.35,Included in ER Case rate,1760.35,1760.35,1815.94,1667.7
97500163,EAP,CPT  49591,,0975,HC PR 49591 RPR AA HERNIA 1ST < 3 CM REDUCIBLE CDM,1,1693,1608.35,1659.14,1608.35,1642.21,1608.35,Current Medicare Rates,1642.21,1625.28,1608.35,1608.35,Included in ER Case rate,1608.35,1608.35,1659.14,1523.7
97500164,EAP,CPT  49592,,0975,HC PR 49592 RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED CDM,1,2139,2032.05,2096.22,2032.05,2074.83,2032.05,Current Medicare Rates,2074.83,2053.44,2032.05,2032.05,Included in ER Case rate,2032.05,2032.05,2096.22,1925.1
97500165,EAP,CPT  49593,,0975,HC PR 49593 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE CDM,1,2139,2032.05,2096.22,2032.05,2074.83,2032.05,Current Medicare Rates,2074.83,2053.44,2032.05,2032.05,Included in ER Case rate,2032.05,2032.05,2096.22,1925.1
97500166,EAP,CPT  49594,,0975,HC PR 49594 RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED CDM,1,2246,2133.7,2201.08,2133.7,2178.62,2133.7,Current Medicare Rates,2178.62,2156.16,2133.7,2133.7,Included in ER Case rate,2133.7,2133.7,2201.08,2021.4
97500167,EAP,CPT  49595,,0975,HC PR 49595 RPR AA HERNIA 1ST > 10 CM REDUCIBLE CDM,1,2246,2133.7,2201.08,2133.7,2178.62,2133.7,Current Medicare Rates,2178.62,2156.16,2133.7,2133.7,Included in ER Case rate,2133.7,2133.7,2201.08,2021.4
97500168,EAP,CPT  49596,,0975,HC PR 49596 RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED CDM,1,2246,2133.7,2201.08,2133.7,2178.62,2133.7,Current Medicare Rates,2178.62,2156.16,2133.7,2133.7,Included in ER Case rate,2133.7,2133.7,2201.08,2021.4
97500169,EAP,CPT  49613,,0975,HC PR 49613 RPR AA HERNIA RECR < 3 CM REDUCIBLE CDM,1,1955,1857.25,1915.9,1857.25,1896.35,1857.25,Current Medicare Rates,1896.35,1876.8,1857.25,1857.25,Included in ER Case rate,1857.25,1857.25,1915.9,1759.5
97500170,EAP,CPT  49614,,0975,HC PR 49614 RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED CDM,1,2239,2127.05,2194.22,2127.05,2171.83,2127.05,Current Medicare Rates,2171.83,2149.44,2127.05,2127.05,Included in ER Case rate,2127.05,2127.05,2194.22,2015.1
97500171,EAP,CPT  49615,,0975,HC PR 49615 RPR AA HERNIA RECR 3-10 CM REDUCIBLE CDM,1,2239,2127.05,2194.22,2127.05,2171.83,2127.05,Current Medicare Rates,2171.83,2149.44,2127.05,2127.05,Included in ER Case rate,2127.05,2127.05,2194.22,2015.1
97500172,EAP,CPT  49616,,0975,HC PR 49616 RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED CDM,1,2239,2127.05,2194.22,2127.05,2171.83,2127.05,Current Medicare Rates,2171.83,2149.44,2127.05,2127.05,Included in ER Case rate,2127.05,2127.05,2194.22,2015.1
97500173,EAP,CPT  49617,,0975,HC PR 49617 RPR AA HERNIA RECR > 10 CM REDUCIBLE CDM,1,2598,2468.1,2546.04,2468.1,2520.06,2468.1,Current Medicare Rates,2520.06,2494.08,2468.1,2468.1,Included in ER Case rate,2468.1,2468.1,2546.04,2338.2
97500174,EAP,CPT  49618,,0975,HC PR 49618 RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED CDM,1,2598,2468.1,2546.04,2468.1,2520.06,2468.1,Current Medicare Rates,2520.06,2494.08,2468.1,2468.1,Included in ER Case rate,2468.1,2468.1,2546.04,2338.2
97500230,EAP,CPT  24105,,0975,HC PR 24105 EXCISION OLECRANON BURSA CDM,1,774,735.3,758.52,735.3,750.78,735.3,Current Medicare Rates,750.78,743.04,735.3,735.3,Included in ER Case rate,735.3,735.3,758.52,696.6
97500235,EAP,CPT  26123,,0975,HC PR 26123 FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR CDM,1,1790,1700.5,1754.2,1700.5,1736.3,1700.5,Current Medicare Rates,1736.3,1718.4,1700.5,1700.5,Included in ER Case rate,1700.5,1700.5,1754.2,1611
97500236,EAP,CPT  26125,,0975,HC PR 26125 FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR CDM,1,571,542.45,559.58,542.45,553.87,542.45,Current Medicare Rates,553.87,548.16,542.45,542.45,Included in ER Case rate,542.45,542.45,559.58,513.9
97500238,EAP,CPT  26418,,0975,HC PR 26418 REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH CDM,1,1434,1362.3,1405.32,1362.3,1390.98,1362.3,Current Medicare Rates,1390.98,1376.64,1362.3,1362.3,Included in ER Case rate,1362.3,1362.3,1405.32,1290.6
97500244,EAP,CPT  26951,,0975,HC PR 26951 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR CDM,1,1600,1520,1568,1520,1552,1520,Current Medicare Rates,1552,1536,1520,1520,Included in ER Case rate,1520,1520,1568,1440
97500253,EAP,CPT  10030,,0975,HC PR 10030 IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE CDM,1,1506,1430.7,1475.88,1430.7,1460.82,1430.7,Current Medicare Rates,1460.82,1445.76,1430.7,1430.7,Included in ER Case rate,1430.7,1430.7,1475.88,1355.4
97500281,EAP,CPT  32557,,0975,HC PR 32557 PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING CDM,1,1476,1402.2,1446.48,1402.2,1431.72,1402.2,Current Medicare Rates,1431.72,1416.96,1402.2,1402.2,Included in ER Case rate,1402.2,1402.2,1446.48,1328.4
97500282,EAP,CPT  27347,,0975,HC PR 27347 EXCISION LESION MENISCUS/CAPSULE KNEE CDM,1,1187,1127.65,1163.26,1127.65,1151.39,1127.65,Current Medicare Rates,1151.39,1139.52,1127.65,1127.65,Included in ER Case rate,1127.65,1127.65,1163.26,1068.3
97500283,EAP,CPT  24665,,0975,HC PR 24665 OPEN TX RADIAL HEAD/NECK FRACTURE CDM,1,1483,1408.85,1453.34,1408.85,1438.51,1408.85,Current Medicare Rates,1438.51,1423.68,1408.85,1408.85,Included in ER Case rate,1408.85,1408.85,1453.34,1334.7
97500285,EAP,CPT  26121,,0975,HC PR 26121 FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT CDM,1,1285,1220.75,1259.3,1220.75,1246.45,1220.75,Current Medicare Rates,1246.45,1233.6,1220.75,1220.75,Included in ER Case rate,1220.75,1220.75,1259.3,1156.5
97510092,EAP,CPT  11646,,0975,HC PR 11646 EXC FACE-MM MLG+MARG > 4 CM,1,1080,1026,1058.4,1026,1047.6,1026,Current Medicare Rates,1047.6,1036.8,1026,1026,Included in ER Case rate,1026,1026,1058.4,972
97510302,EAP,CPT  14020,,0975,"HC PR 14020 SKIN TISSUE REARRANGEMENT 10 SQ CM OR LESS SCALP,ARM LEG",1,1492,1417.4,1462.16,1417.4,1447.24,1417.4,Current Medicare Rates,1447.24,1432.32,1417.4,1417.4,Included in ER Case rate,1417.4,1417.4,1462.16,1342.8
97510333,EAP,CPT  15852,,0975,HC PR 15852 DRESSING CHANGE NOT FOR BURN UNDER ANESTHESIA,1,99,94.05,97.02,94.05,96.03,94.05,Current Medicare Rates,96.03,95.04,94.05,94.05,Included in ER Case rate,94.05,94.05,97.02,89.1
97510405,EAP,CPT  21555,,0975,HC PR 21555 EXC NECK LES SC < 3 CM,1,989,939.55,969.22,939.55,959.33,939.55,Current Medicare Rates,959.33,949.44,939.55,939.55,Included in ER Case rate,939.55,939.55,969.22,890.1
97510445,EAP,CPT  23615,,0975,HC PR 23615 TREAT HUMERUS FRACTURE OPEN,1,1891,1796.45,1853.18,1796.45,1834.27,1796.45,Current Medicare Rates,1834.27,1815.36,1796.45,1796.45,Included in ER Case rate,1796.45,1796.45,1853.18,1701.9
97510467,EAP,CPT  23430,,0975,HC PR 23430 REPAIR TENODESIS OF BICEP,1,1596,1516.2,1564.08,1516.2,1548.12,1516.2,Current Medicare Rates,1548.12,1532.16,1516.2,1516.2,Included in ER Case rate,1516.2,1516.2,1564.08,1436.4
97510484,EAP,CPT  27524,,0975,HC PR 27524 OPEN TX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS REPAIR CDM,1,1696,1611.2,1662.08,1611.2,1645.12,1611.2,Current Medicare Rates,1645.12,1628.16,1611.2,1611.2,Included in ER Case rate,1611.2,1611.2,1662.08,1526.4
97510581,EAP,CPT  44125,,0975,"HC PR 44125 REMOVAL OF SMALL INTESTINE, W/ ENTEROSTOMY",1,2645,2512.75,2592.1,2512.75,2565.65,2512.75,Current Medicare Rates,2565.65,2539.2,2512.75,2512.75,Included in ER Case rate,2512.75,2512.75,2592.1,2380.5
97510623,EAP,CPT  26357,,0975,"HC PR 26357 REPAIR FLEX TENDON,ZONE 2,SECON,HAND,EA",1,1914,1818.3,1875.72,1818.3,1856.58,1818.3,Current Medicare Rates,1856.58,1837.44,1818.3,1818.3,Included in ER Case rate,1818.3,1818.3,1875.72,1722.6
97510626,EAP,CPT  26989,,0975,HC PR 26989 HAND/FINGER SURGERY UNLISTED,1,470,446.5,460.6,446.5,455.9,446.5,Current Medicare Rates,455.9,451.2,446.5,446.5,Included in ER Case rate,446.5,446.5,460.6,423
97510648,EAP,CPT  29828,,0975,HC PR 29828 ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS,1,2004,1903.8,1963.92,1903.8,1943.88,1903.8,Current Medicare Rates,1943.88,1923.84,1903.8,1903.8,Included in ER Case rate,1903.8,1903.8,1963.92,1803.6
97510675,EAP,CPT  29807,,0975,"HC PR 29807 SHLDR ARTHROSCOP,SURG,REPAIR,SLAP LESION",1,2151,2043.45,2107.98,2043.45,2086.47,2043.45,Current Medicare Rates,2086.47,2064.96,2043.45,2043.45,Included in ER Case rate,2043.45,2043.45,2107.98,1935.9
97510676,EAP,CPT  29827,,0975,"HC PR 29827 SHLDR ARTHROSCOP,SURG,W/ROTAT CUFF REPR",1,2283,2168.85,2237.34,2168.85,2214.51,2168.85,Current Medicare Rates,2214.51,2191.68,2168.85,2168.85,Included in ER Case rate,2168.85,2168.85,2237.34,2054.7
97510677,EAP,CPT  29888,,0975,"HC PR 29888 KNEE SCOPE,AID ANT CRUCIATE REPAIR",1,2191,2081.45,2147.18,2081.45,2125.27,2081.45,Current Medicare Rates,2125.27,2103.36,2081.45,2081.45,Included in ER Case rate,2081.45,2081.45,2147.18,1971.9
97510740,EAP,CPT  44960,,0975,"HC PR 44960 APPENDECTOMY, RUPTURED",1,1889,1794.55,1851.22,1794.55,1832.33,1794.55,Current Medicare Rates,1832.33,1813.44,1794.55,1794.55,Included in ER Case rate,1794.55,1794.55,1851.22,1700.1
97510856,EAP,CPT  49320,,0975,HC PR 49320 DIAGNOSTIC LAPAROSCOPY SEPARATE PROC,1,740,703,725.2,703,717.8,703,Current Medicare Rates,717.8,710.4,703,703,Included in ER Case rate,703,703,725.2,666
97510890,EAP,CPT  49999,,0975,HC PR 49999 ABDOMEN SURGERY PROCEDURE,1,2601,2470.95,2548.98,2470.95,2522.97,2470.95,Current Medicare Rates,2522.97,2496.96,2470.95,2470.95,Included in ER Case rate,2470.95,2470.95,2548.98,2340.9
97510907,EAP,CPT  24685,,0975,HC PR 24685 TREAT ULNAR FRACTURE - TRT FX,1,1403,1332.85,1374.94,1332.85,1360.91,1332.85,Current Medicare Rates,1360.91,1346.88,1332.85,1332.85,Included in ER Case rate,1332.85,1332.85,1374.94,1262.7
97510908,EAP,CPT  25075,,0975,HC PR 25075 EXC FOREARM LES SC < 3 CM,1,1192,1132.4,1168.16,1132.4,1156.24,1132.4,Current Medicare Rates,1156.24,1144.32,1132.4,1132.4,Included in ER Case rate,1132.4,1132.4,1168.16,1072.8
97510922,EAP,CPT  26045,,0975,HC PR 26045 RELEASE PALM CONTRACTURE,1,1022,970.9,1001.56,970.9,991.34,970.9,Current Medicare Rates,991.34,981.12,970.9,970.9,Included in ER Case rate,970.9,970.9,1001.56,919.8
97510967,EAP,CPT  27886,,0975,HC PR 27886 AMPUTATION FOLLOW-UP SURGERY,1,1391,1321.45,1363.18,1321.45,1349.27,1321.45,Current Medicare Rates,1349.27,1335.36,1321.45,1321.45,Included in ER Case rate,1321.45,1321.45,1363.18,1251.9
97510979,EAP,CPT  29824,,0975,HC PR 29824 SHOULDER ARTHROSCOPY/SURGERY,1,1451,1378.45,1421.98,1378.45,1407.47,1378.45,Current Medicare Rates,1407.47,1392.96,1378.45,1378.45,Included in ER Case rate,1378.45,1378.45,1421.98,1305.9
97511168,EAP,CPT  44025,,0975,HC PR 44025 INCISION OF LARGE BOWEL,1,2105,1999.75,2062.9,1999.75,2041.85,1999.75,Current Medicare Rates,2041.85,2020.8,1999.75,1999.75,Included in ER Case rate,1999.75,1999.75,2062.9,1894.5
97511169,EAP,CPT  44050,,0975,HC PR 44050 REDUCE BOWEL OBSTRUCTION,1,2010,1909.5,1969.8,1909.5,1949.7,1909.5,Current Medicare Rates,1949.7,1929.6,1909.5,1909.5,Included in ER Case rate,1909.5,1909.5,1969.8,1809
97511303,EAP,CPT  23515,,0975,HC PR 23515 OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION,1,1543,1465.85,1512.14,1465.85,1496.71,1465.85,Current Medicare Rates,1496.71,1481.28,1465.85,1465.85,Included in ER Case rate,1465.85,1465.85,1512.14,1388.7
97511311,EAP,CPT  29826,,0975,HC PR 29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE,1,367,348.65,359.66,348.65,355.99,348.65,Current Medicare Rates,355.99,352.32,348.65,348.65,Included in ER Case rate,348.65,348.65,359.66,330.3
97511328,EAP,CPT  27447,,0975,HC PR 27447 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS,1,2735,2598.25,2680.3,2598.25,2652.95,2598.25,Current Medicare Rates,2652.95,2625.6,2598.25,2598.25,Included in ER Case rate,2598.25,2598.25,2680.3,2461.5
97511348,EAP,CPT  29880,,0975,HC PR 29880 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING,1,1265,1201.75,1239.7,1201.75,1227.05,1201.75,Current Medicare Rates,1227.05,1214.4,1201.75,1201.75,Included in ER Case rate,1201.75,1201.75,1239.7,1138.5
97511352,EAP,CPT  45390,,0975,HC PR 45390 COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION,1,764,725.8,748.72,725.8,741.08,725.8,Current Medicare Rates,741.08,733.44,725.8,725.8,Included in ER Case rate,725.8,725.8,748.72,687.6
97511402,EAP,CPT  29819,,0975,HC PR 29819 SHOULDER ARTHROSCOPY/SURGERY,1,1322,1255.9,1295.56,1255.9,1282.34,1255.9,Current Medicare Rates,1282.34,1269.12,1255.9,1255.9,Included in ER Case rate,1255.9,1255.9,1295.56,1189.8
97511555,EAP,CPT  49418,,0975,HC PR 49418 INSERT PERIT CATH COMP,1,2197,2087.15,2153.06,2087.15,2131.09,2087.15,Current Medicare Rates,2131.09,2109.12,2087.15,2087.15,Included in ER Case rate,2087.15,2087.15,2153.06,1977.3
97511560,EAP,CPT  23073,,0975,HC PR 23073 EXC SHOULDER TUM DEEP 5 CM/>,1,1569,1490.55,1537.62,1490.55,1521.93,1490.55,Current Medicare Rates,1521.93,1506.24,1490.55,1490.55,Included in ER Case rate,1490.55,1490.55,1537.62,1412.1
97511694,EAP,CPT  17999,,0975,HC PR 17999 SKIN TISSUE PROCEDURE,1,1298,1233.1,1272.04,1233.1,1259.06,1233.1,Current Medicare Rates,1259.06,1246.08,1233.1,1233.1,Included in ER Case rate,1233.1,1233.1,1272.04,1168.2
97511762,EAP,CPT  20985,,0975,HC PR 20985 CPTR-ASST DIR MS PX,1,308,292.6,301.84,292.6,298.76,292.6,Current Medicare Rates,298.76,295.68,292.6,292.6,Included in ER Case rate,292.6,292.6,301.84,277.2
97512272,EAP,CPT  27380,,0975,HC PR 27380 REPAIR OF KNEECAP TENDON,1,1346,1278.7,1319.08,1278.7,1305.62,1278.7,Current Medicare Rates,1305.62,1292.16,1278.7,1278.7,Included in ER Case rate,1278.7,1278.7,1319.08,1211.4
97512287,EAP,CPT  27519,,0975,HC PR 27519 TREAT THIGH FX GROWTH PLATE,1,1905,1809.75,1866.9,1809.75,1847.85,1809.75,Current Medicare Rates,1847.85,1828.8,1809.75,1809.75,Included in ER Case rate,1809.75,1809.75,1866.9,1714.5
97512354,EAP,CPT  29806,,0975,HC PR 29806 SHOULDER ARTHROSCOPY/SURGERY,1,2377,2258.15,2329.46,2258.15,2305.69,2258.15,Current Medicare Rates,2305.69,2281.92,2258.15,2258.15,Included in ER Case rate,2258.15,2258.15,2329.46,2139.3
97512961,EAP,CPT  45172,,0975,HC PR 45172 EXC RECT TUM TRANSANAL FULL,1,1768,1679.6,1732.64,1679.6,1714.96,1679.6,Current Medicare Rates,1714.96,1697.28,1679.6,1679.6,Included in ER Case rate,1679.6,1679.6,1732.64,1591.2
97513074,EAP,CPT  54692,,0975,HC PR 54692 LAPAROSCOPY ORCHIOPEXY,1,1593,1513.35,1561.14,1513.35,1545.21,1513.35,Current Medicare Rates,1545.21,1529.28,1513.35,1513.35,Included in ER Case rate,1513.35,1513.35,1561.14,1433.7
97513657,EAP,CPT  24147,,0975,HC PR 24147 PARTIAL REMOVAL OF ELBOW,1,1351,1283.45,1323.98,1283.45,1310.47,1283.45,Current Medicare Rates,1310.47,1296.96,1283.45,1283.45,Included in ER Case rate,1283.45,1283.45,1323.98,1215.9
97514041,EAP,CPT  27337,,0975,HC PR 27337 EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>  CDM,1,946,898.7,927.08,898.7,917.62,898.7,Current Medicare Rates,917.62,908.16,898.7,898.7,Included in ER Case rate,898.7,898.7,927.08,851.4
97514080,EAP,CPT  49521,,0975,HC PR 49521 RPR RECRT INGUN HERNIA ANY AGE INCARCERATED  CDM,1,1543,1465.85,1512.14,1465.85,1496.71,1465.85,Current Medicare Rates,1496.71,1481.28,1465.85,1465.85,Included in ER Case rate,1465.85,1465.85,1512.14,1388.7
97514151,EAP,CPT  28825,,0975,HC PR 28825 AMPUTATION TOE INTERPHALANGEAL JOINT CDM,1,630,598.5,617.4,598.5,611.1,598.5,Current Medicare Rates,611.1,604.8,598.5,598.5,Included in ER Case rate,598.5,598.5,617.4,567
98110088,EAP,CPT  41899,,0981,HC PR ED 41899 UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES CDM,1,348,330.6,341.04,330.6,337.56,330.6,Current Medicare Rates,337.56,334.08,330.6,330.6,Included in ER Case rate,330.6,330.6,341.04,313.2
98110115,EAP,CPT  49451,,0981,HC PR ED 49451 REPLACE DUOD/JEJ TUBE PERC CDM,1,1581,1501.95,1549.38,1501.95,1533.57,1501.95,Current Medicare Rates,1533.57,1517.76,1501.95,1501.95,Included in ER Case rate,1501.95,1501.95,1549.38,1422.9
98110795,EAP,CPT  26765,,0981,HC PR ED 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/THUMB EA CDM,1,1090,1035.5,1068.2,1035.5,1057.3,1035.5,Current Medicare Rates,1057.3,1046.4,1035.5,1035.5,Included in ER Case rate,1035.5,1035.5,1068.2,981
98110858,EAP,CPT  26952,,0981,HC PR ED 26952 AMPUTATE FINGER/THUMB SINGLE W/LOCAL ADV FLAPS CDM,1,1503,1427.85,1472.94,1427.85,1457.91,1427.85,Current Medicare Rates,1457.91,1442.88,1427.85,1427.85,Included in ER Case rate,1427.85,1427.85,1472.94,1352.7
98110884,EAP,CPT  27603,,0981,HC PR ED 27603 DRAIN LOWER LEG LESION DEEP CDM,1,1160,1102,1136.8,1102,1125.2,1102,Current Medicare Rates,1125.2,1113.6,1102,1102,Included in ER Case rate,1102,1102,1136.8,1044
98110910,EAP,CPT  36416,,0981,HC PR ED 36416 CAPILLARY BLOOD DRAW CDM,1,116,110.2,113.68,110.2,112.52,110.2,Current Medicare Rates,112.52,111.36,110.2,110.2,Included in ER Case rate,110.2,110.2,113.68,104.4
98210074,EAP,CPT  27331,,0982,HC PR 27331 EXPLORE/TREAT KNEE JOINT,1,1024,972.8,1003.52,972.8,993.28,972.8,Current Medicare Rates,993.28,983.04,972.8,972.8,Included in ER Case rate,972.8,972.8,1003.52,921.6
98300143,EAP,CPT  11740,,0983,HC PR 11740 EVACUATION SUBUNGUAL HEMATOMA CDM,1,122,115.9,119.56,115.9,118.34,115.9,Current Medicare Rates,118.34,117.12,115.9,115.9,Included in ER Case rate,115.9,115.9,119.56,109.8
98300452,EAP,CPT  99418,,0987,HC PR 99418 PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN CDM,1,79,75.05,77.42,75.05,76.63,75.05,Current Medicare Rates,76.63,75.84,75.05,75.05,Included in ER Case rate,75.05,75.05,77.42,71.1
98310017,EAP,CPT  99499,,0983,"HC PR 99499 EXAM, DOT CNTR",1,152,144.4,148.96,144.4,147.44,144.4,Current Medicare Rates,147.44,145.92,144.4,144.4,Included in ER Case rate,144.4,144.4,148.96,136.8
98310386,EAP,CPT  84703,,0983,HC PR 84703 CHORIONIC GONADOTROPIN ASSAY,1,104,98.8,101.92,98.8,100.88,98.8,Current Medicare Rates,100.88,99.84,98.8,98.8,Included in ER Case rate,98.8,98.8,101.92,93.6
98310855,EAP,CPT  29581,,0983,HC PR 29581 MULTILAYER WND COMPRESSION,1,192,182.4,188.16,182.4,186.24,182.4,Current Medicare Rates,186.24,184.32,182.4,182.4,Included in ER Case rate,182.4,182.4,188.16,172.8
98311030,EAP,CPT  20551,,0983,HC PR 20551 INJECTION SINGLE TENDON ORIGIN/INSERTION,1,130,123.5,127.4,123.5,126.1,123.5,Current Medicare Rates,126.1,124.8,123.5,123.5,Included in ER Case rate,123.5,123.5,127.4,117
98311191,EAP,Custom   98311191,,0983,HC PR DINOPROSTONE VAG INSERT,1,886,841.7,868.28,841.7,859.42,841.7,Current Medicare Rates,859.42,850.56,841.7,841.7,Included in ER Case rate,841.7,841.7,868.28,797.4
98311198,EAP,Custom   98311198,,0983,HC PR HYDROCODONE/ACET TAB (5/3,1,7,6.65,6.86,6.65,6.79,6.65,Current Medicare Rates,6.79,6.72,6.65,6.65,Included in ER Case rate,6.65,6.65,6.86,6.3
98311199,EAP,Custom   98311199,,0983,HC PR IPRATROPIUM & ALBUTEROL,1,13,12.35,12.74,12.35,12.61,12.35,Current Medicare Rates,12.61,12.48,12.35,12.35,Included in ER Case rate,12.35,12.35,12.74,11.7
98311200,EAP,Custom   98311200,,0983,HC PR IV-SOD CHLORIDE 0.9 %  (1,1,114,108.3,111.72,108.3,110.58,108.3,Current Medicare Rates,110.58,109.44,108.3,108.3,Included in ER Case rate,108.3,108.3,111.72,102.6
98311201,EAP,Custom   98311201,,0983,HC PR IV-SOD CHLORIDE 0.9%  (50,1,102,96.9,99.96,96.9,98.94,96.9,Current Medicare Rates,98.94,97.92,96.9,96.9,Included in ER Case rate,96.9,96.9,99.96,91.8
98311204,EAP,Custom   98311204,,0983,HC PR LIDOCAINE  JELLY UROJET,1,42,39.9,41.16,39.9,40.74,39.9,Current Medicare Rates,40.74,40.32,39.9,39.9,Included in ER Case rate,39.9,39.9,41.16,37.8
98311205,EAP,Custom   98311205,,0983,HC PR LORAZEPAM TAB (0.5 MG),1,7,6.65,6.86,6.65,6.79,6.65,Current Medicare Rates,6.79,6.72,6.65,6.65,Included in ER Case rate,6.65,6.65,6.86,6.3
98311209,EAP,Custom   98311209,,0983,HC PR ONDANSETRON ODT TAB (4 MG,1,86,81.7,84.28,81.7,83.42,81.7,Current Medicare Rates,83.42,82.56,81.7,81.7,Included in ER Case rate,81.7,81.7,84.28,77.4
98311330,EAP,CPT  99455,,0983,HC PR 99455 CC ACP DOT PX,1,264,250.8,258.72,250.8,256.08,250.8,Current Medicare Rates,256.08,253.44,250.8,250.8,Included in ER Case rate,250.8,250.8,258.72,237.6
3254557WWM,EAP,Custom   3254557WWM,,0270,HC DRSG THERAHONEY 4X5 MNK0087,1,45,42.75,44.1,42.75,43.65,42.75,Current Medicare Rates,43.65,43.2,42.75,42.75,Included in ER Case rate,42.75,42.75,44.1,40.5